Healthcare Provider Details

I. General information

NPI: 1194955229
Provider Name (Legal Business Name): LANCE GREGORY WESTERLUND REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

IV. Provider business mailing address

1511 NORTHWAY DR STE 101
SAINT CLOUD MN
56303-1262
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-1670
  • Fax:
Mailing address:
  • Phone: 320-654-8266
  • Fax: 320-654-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1535383
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: