Organization
NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY MARIAN NELMS MCCABE M.D. (PARTNER)
(651) 251-5280
Entity
Organization
Contact information
Practice address
3555 WILLOW LAKE BLVD., SUITE 140, VADNAIS HEIGHTS, MN 55110-4462
(651) 251-5280
(651) 251-5282
Mailing address
3555 WILLOW LAKE BLVD., SUITE 140, VADNAIS HEIGHTS, MN 55110-4462
(651) 251-5280
(651) 251-5282
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
165339
UCARE
MN
01
—
29960NO
BCBS MN
MN
05
—
744432000
—
MN
Enumeration date
12/14/2006
Last updated
05/20/2009
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