Healthcare Provider Details

I. General information

NPI: 1881619872
Provider Name (Legal Business Name): JOAN MICHELLE GELINEAU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOAN MICHELLE MONTAGUE

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 4TH ST
TWO HARBORS MN
55616-1200
US

IV. Provider business mailing address

1010 4TH ST
TWO HARBORS MN
55616-1200
US

V. Phone/Fax

Practice location:
  • Phone: 218-834-7200
  • Fax: 218-834-7220
Mailing address:
  • Phone: 218-834-7200
  • Fax: 218-834-7220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 070516-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: