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General NPI Number Information
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NPI Number | 1699264010
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Entity Type | Organization
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Legal Business Name | HOUSECALL CLINIC P.L.L.C.
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 107 1ST ST SE STE 102
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3074
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Country | US
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Telephone | 320-733-0174
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Fax |
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Provider Business Mailing Address
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Address Line | 107 1ST ST SE STE 102
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3074
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Country | US
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Telephone | 320-733-0174
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Fax |
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Authorized Official
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Title or Position | OWNER, MANAGER
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Name | MARILYN HUSBY
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Credential | APRN, CNP
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Telephone | 320-733-0174
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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 | 730927
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License Number State | MN
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