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Organization

HERMSEN HEALTH AND WELLNESS, PLLC

Active
Other names
HealthSource of Prior Lake
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SAMANTHA MARIE HERMSEN D.C. (CHIEF MANAGER)
(920) 371-2702
Entity
Organization

Contact information

Practice address
6880 BOUDIN ST NE STE 230, PRIOR LAKE, MN 55372-1510
(952) 447-0985
(952) 447-0986
Mailing address
8791 KNOLLWOOD DR, EDEN PRAIRIE, MN 55347-1719
(952) 447-0985
(952) 447-0986

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5713
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1043555055
INDIVIDUAL PROVIDER NPI
MN
01
350005214
MEDICARE PTAN
MN
Enumeration date
01/13/2015
Last updated
01/13/2015
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