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General NPI Number Information
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NPI Number | 1588574396
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Entity Type | Organization
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Legal Business Name | DIRECT PAY VIRTUAL CLINIC LLC
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Dates
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Enumeration Date | 09/11/2026
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Last Update Date | 09/11/2026
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Provider Practice Location Address
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Address Line | 9605 HIGHWAY 65
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City | BRITT
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State | MN
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Zip | 55710-8244
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Country | US
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Telephone | 917-295-7064
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Fax |
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Provider Business Mailing Address
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Address Line | 9605 HIGHWAY 65
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City | BRITT
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State | MN
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Zip | 55710-8244
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEGAN LUNDBERG
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Credential |
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Telephone | 917-295-7064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | NULL
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