Northern Waters Clinic
LBN: Northern Waters Clinic, Pllc
Northern Waters Clinic is an health care organization with primary practice located at 4899 Miller Trunk Hwy Ste 208 , Hermantown MN 55811-1582. The organization recently has 3 registered licenses in different health care specialties including Nursing Service Providers / Psychiatric/Mental Health, Child & Adolescent, Nursing Service Providers / Psychiatric/Mental Health, Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center). Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) is the primary health care specialty.
Northern Waters Clinic, Pllc can be contacted via phone (218) 391-9860, or through Maki, Melissa Ann via phone (218) 727-3888.
Contact Information
Primary practice address
4899 Miller Trunk Hwy Ste 208
Hermantown MN 55811-1582
Phone: (218) 391-9860
Fax: (218) 391-9860
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing Service Providers / Psychiatric/Mental Health, Child & Adolescent | 163WP0807X | 2318 | Minnesota |
| Nursing Service Providers / Psychiatric/Mental Health | 163WP0808X | 2318 | Minnesota |
| Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) | 261QM0801X |
Profile Details
| NPI number | 1316445455 |
|---|---|
| LBN Legal business name | Northern Waters Clinic, Pllc |
| DBA Doing business as | Northern Waters Clinic |
| Authorized official | Maki, Melissa Ann Nurse Practitioner (NP) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jan 23rd, 2018 |
| Last updated | Mar 24th, 2021 - about 3 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316445455 | NPPES |
| Minnesota | MEDICAID | 1295014520 |
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