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Organization
NORTHERN LIGHTS HEALTH LLC
Active
Organization
NORTHERN LIGHTS HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE M SIDDONS FNP-C (CO-FOUNDER)
(920) 217-9035
Entity
Organization
Contact information
Practice address
212 W LAKE ST, WACONIA, MN 55387-1014
(920) 217-9035
Mailing address
212 W LAKE ST, WACONIA, MN 55387-1014
(920) 217-9035
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
—
NULL
363LA2100X
Acute Care Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
NULL
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
NULL
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
NULL
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/31/2019
Last updated
12/22/2019
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