MEDICARE: ABBOTT NORTHWESTERN HOSPITAL

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
1	282NC0060X	Critical Access Hospital	R090636-6	MN

General Provider Information

NPI Number	:	1316960305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABBOTT NORTHWESTERN HOSPITAL

Provider Business Mailing Address
First Line	:	4165 CASHELL GLN
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-2819
Country	:	US
Telephone Number	:	651-251-3052
Fax Number	:

Provider Business Practice Location Address
First Line	:	4165 CASHELL GLN
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55122-2819
Country	:	US
Telephone Number	:	651-251-3053
Fax Number	:

Authorized Official
Title or Position	:	RN
Name	:	CHERYLE LINDA JESINOSKI
Credential	:
Telephone Number	:	612-863-4478

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	06/13/2008

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