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General NPI Number Information
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NPI Number | 1568050342
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Entity Type | Organization
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Legal Business Name | MN WELLNESS
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 1900 COUNTY ROAD D E STE 100
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City | MAPLEWOOD
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State | MN
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Zip | 55109-4570
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Country | US
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Telephone | 612-423-8330
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Fax |
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Provider Business Mailing Address
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Address Line | 3441 170TH LN NE
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City | HAM LAKE
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State | MN
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Zip | 55304-5252
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Country | US
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Telephone | 763-670-2493
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Fax |
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | STEPHANIE SILL
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Credential | BSDH
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Telephone | 763-670-2493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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