Healthcare Provider Details

I. General information

NPI: 1992851216
Provider Name (Legal Business Name): NORMANDALE COMMUNITY COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 FRANCE AVE S
BLOOMINGTON MN
55431-4309
US

IV. Provider business mailing address

9700 FRANCE AVE S
BLOOMINGTON MN
55431-4309
US

V. Phone/Fax

Practice location:
  • Phone: 952-487-7020
  • Fax: 952-487-7173
Mailing address:
  • Phone: 952-487-7020
  • Fax: 952-487-7173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateMN

VIII. Authorized Official

Name: MR. CRAIG ERICKSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 952-487-8232