Organization
GROUP HEALTH PLAN, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID DZIUK (SVP, CFO)
(952) 883-6535
Entity
Organization
Contact information
Practice address
2165 WHITE BEAR AVE N, MAPLEWOOD, MN 55109-2707
(952) 883-7505
Mailing address
2165 WHITE BEAR AVE N, MAPLEWOOD, MN 55109-2707
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP 4768
MN
Other
Enumeration date
10/19/2016
Last updated
10/19/2016
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