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General NPI Number Information
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NPI Number | 1699397851
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Entity Type | Organization
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Legal Business Name | SCHOOL OF HEALTH LLC
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 30165 TERRYLL ST
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City | LINDSTROM
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State | MN
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Zip | 55045-9310
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Country | US
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Telephone | 651-808-2640
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Fax |
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Provider Business Mailing Address
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Address Line | 30165 TERRYLL ST
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City | LINDSTROM
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State | MN
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Zip | 55045-9310
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Country | US
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Telephone | 651-808-2640
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Fax |
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Authorized Official
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Title or Position | CERTIFIED NURSE PRACTITIONER
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Name | EGLE P OTTO
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Credential | DNP
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Telephone | 651-808-2640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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