Healthcare Provider Details

I. General information

NPI: 1871651646
Provider Name (Legal Business Name): NORTHERN PINES MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5211 HWY 110
AURORA MN
55705
US

IV. Provider business mailing address

5211 HWY 110
AURORA MN
55705
US

V. Phone/Fax

Practice location:
  • Phone: 218-229-2211
  • Fax: 218-229-2042
Mailing address:
  • Phone: 218-229-2211
  • Fax: 218-229-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAURA JANE ACKMAN
Title or Position: CEO
Credential:
Phone: 218-229-2211