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Organization
AVERA MCKENNAN
Active
Organization
AVERA MCKENNAN
Active
Other names
Avera McKennan dba Avera Worthington Specialty Clinics, Avera Medical Group Worthington
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE N NORTON (CFO/SVP)
(605) 322-7818
Entity
Organization
Contact information
Practice address
1216 RYANS RD, SUITE 1, WORTHINGTON, MN 56187-1722
(507) 372-2921
(507) 372-5789
Mailing address
1216 RYANS RD, SUITE 1, WORTHINGTON, MN 56187-1722
(507) 372-2921
(507) 372-5789
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
951015000
—
MN
Enumeration date
10/02/2006
Last updated
05/31/2017
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