Organization
PARK NICOLLET HEALTH CARE PRODUCTS
Active
Parent organization
PARK NICOLLET HEALTH SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
PARK NICOLLET HEALTH SERVICES
Authorized official
KRISTIN DENISE BREY (SUPERVISOR/DELEGATED OFFICIAL)
(952) 993-6832
Entity
Organization
Contact information
Practice address
3850 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416-2527
(952) 993-1330
(952) 993-0562
Mailing address
3800 PARK NICOLLET BLVD # MS 61901C, ST LOUIS PARK, MN 55416-2527
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2419617
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
364280100
—
MN
Enumeration date
03/20/2006
Last updated
11/07/2024
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