Healthcare Provider Details

I. General information

NPI: 1699652883
Provider Name (Legal Business Name): RADIANT HEALTH COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 CENTRAL AVE
OSSEO MN
55369-4794
US

IV. Provider business mailing address

240 CENTRAL AVE
OSSEO MN
55369-4794
US

V. Phone/Fax

Practice location:
  • Phone: 612-670-4870
  • Fax:
Mailing address:
  • Phone: 612-208-3725
  • Fax: 888-711-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HANNAH LEWIS
Title or Position: OWNER
Credential: CNP
Phone: 612-208-3725