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General NPI Number Information
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NPI Number | 1629333117
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTHCARE AND PHYSICAL MEDICINE, PLLC
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 2151 HAMLINE AVE N SUITE 111
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City | ROSEVILLE
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State | MN
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Zip | 55113-4236
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Country | US
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Telephone | 651-636-5560
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Fax | 651-636-4406
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Provider Business Mailing Address
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Address Line | 2151 HAMLINE AVE N SUITE 111
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City | ROSEVILLE
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State | MN
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Zip | 55113-4236
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Country | US
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Telephone | 651-636-5560
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Fax | 651-636-4406
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JENNIFER NORINE
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Credential |
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Telephone | 651-636-5560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | R153252-2
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License Number State | MN
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