Basic Information
| Provider Information | |||||||||
| NPI: | 1265802128 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALINA HEALTH COON RAPIDS CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16263 QUIET VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | LINDSTROM | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550459675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6515877818 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9055 SPRINGBROOK DR NW | ||||||||
| Address2: | |||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554335841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637809155 | ||||||||
| FaxNumber: | 7632361312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2015 | ||||||||
| LastUpdateDate: | 10/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | MELQUIST | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | FAMILY NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 6515877818 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ALINA HEALTH SYSTEM | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | FNP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | MN | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.