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General NPI Number Information
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NPI Number | 1649296245
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Entity Type | Organization
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Legal Business Name | NORTHLAND NEUROLOGY AND MYOLOGY PA
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 130 7TH AVE W
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City | FLOODWOOD
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State | MN
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Zip | 55736-1200
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Country | US
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Telephone | 218-722-1122
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Fax | 218-722-0600
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Provider Business Mailing Address
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Address Line | 130 7TH AVE W
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City | FLOODWOOD
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State | MN
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Zip | 55736-1200
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Country | US
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Telephone | 218-722-1122
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Fax | 218-722-0600
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ALISSA MARSHALL
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Credential |
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Telephone | 218-722-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1385
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License Number State | MN
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