Organization
PRAIRIE ST. JOHNS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GINA KINNAMON (EXECUTIVE ASSISTANT)
(701) 476-7208
Entity
Organization
Contact information
Practice address
11610 WAYZATA BLVD, MINNETONKA, MN 55305-2009
(952) 230-9180
Mailing address
110 W GRANT ST APT 9J, MINNEAPOLIS, MN 55403-2311
(612) 940-1546
Taxonomy
Speciality
Code
Description
License number
State
282NC2000X
Children's Hospital
Primary
14993
MN
Other
Enumeration date
03/07/2007
Last updated
08/22/2020
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