Healthcare Provider Details

I. General information

NPI: 1114225703
Provider Name (Legal Business Name): NESS PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 CAMPUS DR SUITE 485
PLYMOUTH MN
55441-2676
US

IV. Provider business mailing address

1952 LUCILLE LN
SAINT CLOUD MN
56303-0434
US

V. Phone/Fax

Practice location:
  • Phone: 763-559-4500
  • Fax: 763-559-1733
Mailing address:
  • Phone: 763-559-4500
  • Fax: 763-559-1733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number36379
License Number StateMN

VIII. Authorized Official

Name: DR. JOHN ALLAN NESS
Title or Position: OWNER
Credential: MD
Phone: 763-559-4500