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NPI Code Detail

MEDICARE: MINUTECLINIC PRIMARY CARE MINNESOTA PLLC

MEDICARE: MINUTECLINIC PRIMARY CARE MINNESOTA PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1104632801
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINUTECLINIC PRIMARY CARE MINNESOTA PLLC
Provider Business Mailing Address
First Line : PO BOX 772
Second Line :
City : WOONSOCKET
State : RI
Zip : 02895-0784
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4241 JOHNNY CAKE RIDGE RD
Second Line :
City : EAGAN
State : MN
Zip : 55122-2235
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : DEBORAH PINCINCE
Credential :
Telephone Number : 866-389-2727
Provider Enumeration Date : 12/06/2024
Last Update Date : 03/24/2026

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