MEDICARE: PROCONCIERGE NURSING SERVICE, 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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1811596984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROCONCIERGE NURSING SERVICE, LLC

Provider Business Mailing Address
First Line	:	13526 CAMP AVE
Second Line	:
City	:	WALNUT GROVE
State	:	MN
Zip	:	56180-5343
Country	:	US
Telephone Number	:	507-626-5638
Fax Number	:

Provider Business Practice Location Address
First Line	:	13526 CAMP AVE
Second Line	:
City	:	WALNUT GROVE
State	:	MN
Zip	:	56180-5343
Country	:	US
Telephone Number	:	507-626-5638
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JILL STOKS
Credential	:	RN
Telephone Number	:	507-626-5638

Provider Enumeration Date	:	10/20/2020
Last Update Date	:	10/20/2020

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