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General NPI Number Information
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NPI Number | 1689095051
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Entity Type | Organization
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Legal Business Name | NEW LEAF CENTERS PLLC
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 5000 W 36TH ST STE 205
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2760
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Country | US
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Telephone | 952-807-0415
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Fax | 952-426-3032
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Provider Business Mailing Address
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Address Line | 5000 W 36TH ST STE 205
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2760
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Country | US
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Telephone | 952-807-0415
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Fax | 952-426-3032
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Authorized Official
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Title or Position | MANAGER
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Name | CHERYL LANDWEHR
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Credential |
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Telephone | 952-801-0415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1336125111
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License Number State | MN
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