NORTHERN LIGHTS HEALTH LLC (NPI# 1316581440) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316581440 |
| Entity Type | Organization |
| Organization Name | NORTHERN LIGHTS HEALTH LLC |
| Practice Address |
212 W Lake St Waconia MN 55387-1014 |
| Practice Telephone | 9202179035 |
| Mailing Telephone | 9202179035 |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2019-12-22 |
| Authorized Official Name | NICOLE M SIDDONS (CO-FOUNDER) |
| Authorized Official Telephone | 9202179035 |
| Authorized Official Credential | FNP-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
212 W LAKE ST |
| City | WACONIA |
| State | MN |
| Zip Code | 55387-1014 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780223743 | Waterside Healthcare & Wellness, LLC | Nurse Practitioner | 212 W Lake St, Waconia, MN 55387-1014 | 2019-12-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023626256 | Katelyn Neufeld | Midwife | Western Obgyn 560 S Maple St, Suite 130, Waconia, MN 55387 | 2020-07-14 |
| 1871074674 | Ashley Bea Johnson | Registered Nurse | 1866 Sandbar Cir, Waconia, MN 55387 | 2018-08-28 |
| 1740642529 | Ryan Christenson | Chiropractor | 32 E Main St., Waconia, MN 55387 | 2016-03-22 |
| 1942638481 | Katie Elizabeth Leuning-pavek | Marriage & Family Therapist | 1657 Interlaken Ct, Waconia, MN 55387 | 2013-10-18 |
| 1083964837 | Auburn Meadows, LLC | Assisted Living Facility | 591 S. Cherry Dr, Waconia, MN 55387 | 2012-09-19 |
| 1114238821 | Jalissa Joy Kruckman | Dentist | 576 Cherry Dr, Waconia, MN 55387 | 2010-06-28 |
| 1194990143 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 121 Depot Dr, Waconia, MN 55387 | 2008-04-29 |
| 1417156662 | Heather Anne Noel Tuttle | Optometrist | 753 Marketplace Drive, Waconia, MN 55387 | 2007-07-17 |
| 1366507436 | Waconia School District | Local Education Agency (LEA) | 512 Industrial Blvd, Waconia, MN 55387 | 2006-12-27 |
| 1295898872 | Haven Chemical Health Systems | Counselor | 233 1st St W, Waconia, MN 55387 | 2006-12-18 |
| Find all providers in zip 55387 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467071084 | St. Catherine University School Based Health Clinic | Nurse Practitioner | 5045 Division Ave, White Bear Lake, MN 55110 | 2020-04-14 |
| 1669005948 | Kevin Charles Carlson | Nurse Practitioner | 19303 Sorrel Ct, Corcoran, MN 55340-4447 | 2020-02-14 |
| 1144862996 | Alade Lateef Hamza | Nurse Practitioner | 4808 85th Ave N Ste 300, Brooklyn Park, MN 55443-1816 | 2019-10-14 |
| 1114584869 | Tenzin Lhamo | Nurse Practitioner | 195 Windsor Ln, New Brighton, MN 55112-3366 | 2019-05-28 |
| 1255834859 | Ashley M Morehouse | Nurse Practitioner | 625 S 4th St Ste A, Le Sueur, MN 56058-2203 | 2018-03-10 |
| 1013457381 | Lydia Nyakonu Sherman | Nurse Practitioner | 606 24th Ave S #620, Minneapolis, MN 55454 | 2017-03-06 |
| 1912447780 | Zillah Mulubisha | Nurse Practitioner | Brooklyn Park Clinic, 7650 Zane Ave N, Minneapolis, MN 55443 | 2017-02-27 |
| 1245615194 | Jennifer Nelson | Nurse Practitioner | 480 Osborne Rd Ne Ste 220, Fridley, MN 55432-2866 | 2015-07-21 |
| 1912397142 | Solomon Africanus Wesseh Jr. | Nurse Practitioner | 10135 43rd Ct Ne, Saint Michael, MN 55376-3015 | 2015-01-26 |
| 1780084004 | Angela Rae Fox | Nurse Practitioner | 7383 Upper 157th St W, Apple Valley, MN 55124-5108 | 2014-08-25 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on NORTHERN LIGHTS HEALTH LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.