Healthcare Provider Details

I. General information

NPI: 1033641352
Provider Name (Legal Business Name): ASPEN MEDICAL STAFFING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1894 37TH ST SE
SAINT CLOUD MN
56304-9508
US

IV. Provider business mailing address

1894 37TH ST SE
ST. CLOUD MN
56304
US

V. Phone/Fax

Practice location:
  • Phone: 320-227-2606
  • Fax:
Mailing address:
  • Phone: 320-227-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1955
License Number StateSD

VIII. Authorized Official

Name: KEVIN O'NEIL
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 763-226-6046