Organization
NW FAMILY PRACTICE ROGERS
Active
Organization
NW FAMILY PRACTICE ROGERS
Active
Other names
NW FAMILY PRACTICE ROGERS
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
21305 JOHN MILLESS DR, ROGERS, MN 55374-9450
(612) 428-2206
(612) 428-2530
Mailing address
21305 JOHN MILLESS DR, ROGERS, MN 55374-9450
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
17330
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2423616
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/23/2006
Last updated
08/22/2020
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