=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093700841
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POPE COUNTY PUBLIC HEALTH NURSING SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 MINNESOTA AVE E SUITE 100
-----------------------------------------------------
City | GLENWOOD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56334-1629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-634-5720
-----------------------------------------------------
Fax | 320-634-0159
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 MINNESOTA AVE E SUITE 100
-----------------------------------------------------
City | GLENWOOD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56334-1629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-634-5720
-----------------------------------------------------
Fax | 320-634-0159
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. SHARON BRAATEN
-----------------------------------------------------
Credential | RN PHN
-----------------------------------------------------
Telephone | 320-634-5720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------