| Minnesota Wellcare Llc | |
|
10519 165th St W Lakeville MN 55044-5722 | |
| (952) 248-2719 | |
| Not Available |
| Full Name | Minnesota Wellcare Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 10519 165th St W, Lakeville, Minnesota |
| Authorized Official Name and Position | Katie Kocina (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9522482719 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Minnesota Wellcare Llc 10519 165th St W Lakeville MN 55044-5722 Ph: (952) 248-2719 | Minnesota Wellcare Llc 10519 165th St W Lakeville MN 55044-5722 Ph: (952) 248-2719 |
| NPI Number | 1801548748 |
|---|---|
| Provider Enumeration Date | 01/21/2022 |
| Last Update Date | 03/29/2022 |
| Certification Date | 03/29/2022 |
| Medicare PECOS PAC ID | 5991182941 |
|---|---|
| Medicare Enrollment ID | O20220513001479 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801548748 | NPI | - | NPPES |
| Provider Name | Brooke E Kern |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033576046 PECOS PAC ID: 8628374857 Enrollment ID: I20160314001537 |
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