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General NPI Number Information
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NPI Number | 1508882754
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Entity Type | Organization
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Legal Business Name | ST. CLOUD EAR, NOSE & THROAT CLINIC, P.A.
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 1528 NORTHWAY DR
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1255
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Country | US
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Telephone | 320-252-0233
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Fax |
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Provider Business Mailing Address
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Address Line | 1528 NORTHWAY DR
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1255
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Country | US
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Telephone | 320-252-0233
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Fax |
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | AMANDA RAE RESSEMANN
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Credential |
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Telephone | 320-257-1167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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