Organization
WATERSIDE HEALTHCARE & WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE M SIDDONS FNP-C (OWNER OF ENTITY)
(920) 217-9035
Entity
Organization
Contact information
Practice address
212 W LAKE ST, WACONIA, MN 55387-1014
(920) 217-9035
Mailing address
212 W LAKE ST, WACONIA, MN 55387-1014
(920) 217-9035
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/22/2019
Last updated
12/22/2019
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