Healthcare Provider Details

I. General information

NPI: 1720912652
Provider Name (Legal Business Name): ESSENTIAL PREMIUM HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 ASH AVE NW
SAINT MICHAEL MN
55376-1013
US

IV. Provider business mailing address

413 ASH AVE NW
SAINT MICHAEL MN
55376-1013
US

V. Phone/Fax

Practice location:
  • Phone: 763-439-3157
  • Fax:
Mailing address:
  • Phone: 763-439-3157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NADU MADJE LAWSON ZANKLI
Title or Position: OWNER
Credential:
Phone: 763-439-3157