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General NPI Number Information
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NPI Number | 1831941970
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Entity Type | Organization
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Legal Business Name | TWIN PORTS TELEMEDICINE LLC
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Dates
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Enumeration Date | 04/02/2024
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 4727 AUNE RD
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City | SAGINAW
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State | MN
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Zip | 55779-9682
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Country | US
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Telephone | 218-391-6264
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Fax |
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Provider Business Mailing Address
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Address Line | 4727 AUNE RD
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City | SAGINAW
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State | MN
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Zip | 55779-9682
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Country | US
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Telephone | 218-391-6264
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE SHOCKLEY
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Credential | APRN
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Telephone | 888-820-1235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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