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General NPI Number Information
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NPI Number | 1699652883
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Entity Type | Organization
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Legal Business Name | RADIANT HEALTH COLLECTIVE LLC
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 240 CENTRAL AVE
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City | OSSEO
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State | MN
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Zip | 55369-4794
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Country | US
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Telephone | 612-670-4870
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Fax |
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Provider Business Mailing Address
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Address Line | 240 CENTRAL AVE
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City | OSSEO
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State | MN
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Zip | 55369-4794
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Country | US
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Telephone | 612-208-3725
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Fax | 888-711-4015
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Authorized Official
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Title or Position | OWNER
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Name | HANNAH LEWIS
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Credential | CNP
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Telephone | 612-208-3725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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