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General NPI Number Information
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NPI Number | 1649855479
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Entity Type | Organization
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Legal Business Name | GATHERWELL, PLLC
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Dates
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Enumeration Date | 03/12/2021
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 17565 CENTRAL AVE NE STE 220
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City | HAM LAKE
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State | MN
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Zip | 55304-2230
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Country | US
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Telephone | 612-636-1553
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Fax |
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Provider Business Mailing Address
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Address Line | 17565 CENTRAL AVE NE STE 200
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City | HAM LAKE
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State | MN
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Zip | 55304-2230
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Country | US
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Telephone | 612-806-1546
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Fax | 607-260-0160
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Authorized Official
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Title or Position | OWNER
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Name | SARAH MARIE BROWN
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Credential | MSN, APRN, FNP-C
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Telephone | 612-806-1546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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