Healthcare Provider Details

I. General information

NPI: 1598139677
Provider Name (Legal Business Name): ALICIA REMER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43500 MIGIZI DR
ONAMIA MN
56359-2241
US

IV. Provider business mailing address

43500 MIGIZI DR
ONAMIA MN
56359-2241
US

V. Phone/Fax

Practice location:
  • Phone: 320-532-4163
  • Fax: 320-532-7573
Mailing address:
  • Phone: 320-532-4163
  • Fax: 320-532-7573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR228422-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: