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General NPI Number Information
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NPI Number | 1316581440
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Entity Type | Organization
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Legal Business Name | NORTHERN LIGHTS HEALTH LLC
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Dates
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Enumeration Date | 10/31/2019
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Last Update Date | 12/22/2019
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Provider Practice Location Address
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Address Line | 212 W LAKE ST
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City | WACONIA
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State | MN
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Zip | 55387-1014
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Country | US
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Telephone | 920-217-9035
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Fax |
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Provider Business Mailing Address
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Address Line | 212 W LAKE ST
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City | WACONIA
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State | MN
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Zip | 55387-1014
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Country | US
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Telephone | 920-217-9035
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | NICOLE M SIDDONS
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Credential | FNP-C
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Telephone | 920-217-9035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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