National Provider Identifier Database

NORTHERN LIGHTS PEDIATRIC ADOLESCENT MEDICINE
Adolescent Medicine

A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.


Contact Information

NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE
3555 WILLOW LAKE BLVD.
SUITE 140
VADNAIS HEIGHTS, MN55110-4462
Phone: 651-251-5280
Fax: 651-251-5282
Website:
Specialty Taxonomy Code
* Adolescent Medicine 2080A0000X

* Indicates primary specialty

NPI Profile & details for NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE

NPI Number 1912069519
Legal business name
LBN
NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE
Authorized official WENDY MCCABE - (PARTNER)
Entity Organization
Organization subpart No
Enumeration date 12/14/2006
Last updated 05/20/2009 - About 17 years ago
Sole proprietor1 Not specified
Identifiers
  • MN Medicaid: 744432000
  • MN Other: 29960NO BCBS MN
  • MN Other: 165339 UCARE

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

Reviews for NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE

There are currently no reviews for NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE


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