Healthcare Provider Details

I. General information

NPI: 1093559908
Provider Name (Legal Business Name): RACHEL LYNN FROST PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4891 MILLER TRUNK HWY STE 206
HERMANTOWN MN
55811-1563
US

IV. Provider business mailing address

4891 MILLER TRUNK HWY STE 206
HERMANTOWN MN
55811-1563
US

V. Phone/Fax

Practice location:
  • Phone: 218-306-8383
  • Fax: 218-875-6315
Mailing address:
  • Phone: 218-306-8383
  • Fax: 218-875-6315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11702
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: