MEDICARE: NORTHERN GLOW MENTAL HEALTH LLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1790613826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN GLOW MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	2007 N 3RD AVE E
Second Line	:
City	:	NEWTON
State	:	IA
Zip	:	50208-2522
Country	:	US
Telephone Number	:	563-299-9692
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 1ST AVE W
Second Line	:
City	:	NEWTON
State	:	IA
Zip	:	50208-2932
Country	:	US
Telephone Number	:	515-373-5850
Fax Number	:

Authorized Official
Title or Position	:	PMHNP
Name	:	EMILY HANSEN
Credential	:	MSN, ARNP
Telephone Number	:	563-299-9692

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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