Healthcare Provider Details

I. General information

NPI: 1780874065
Provider Name (Legal Business Name): NORTHLAND FAMILY PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

407 E 3RD ST
DULUTH MN
55805-1950
US

IV. Provider business mailing address

407 E 3RD ST
DULUTH MN
55805-1950
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-2378
  • Fax:
Mailing address:
  • Phone: 218-786-2378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE BLASCYK
Title or Position: DIRECTOR
Credential:
Phone: 218-786-2378