| Dakota Child And Family Clinic Pa | |
|
2530 Horizon Dr Burnsville MN 55337-3091 | |
| (651) 209-8640 | |
| Not Available |
| Full Name | Dakota Child And Family Clinic Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 2530 Horizon Dr, Burnsville, Minnesota |
| Authorized Official Name and Position | Nikki Rose (MEDICAL BILLING) |
| Authorized Official Contact | 6512098640 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dakota Child And Family Clinic Pa 2530 Horizon Dr Burnsville MN 55337-3091 Ph: (651) 209-8640 | Dakota Child And Family Clinic Pa 2530 Horizon Dr Burnsville MN 55337-3091 Ph: (651) 209-8640 |
| NPI Number | 1124377296 |
|---|---|
| Provider Enumeration Date | 09/05/2012 |
| Last Update Date | 03/16/2022 |
| Medicare PECOS PAC ID | 2365676244 |
|---|---|
| Medicare Enrollment ID | O20131008001181 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124377296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1854 (Minnesota) | Primary |
| Provider Name | Gretchen A Moen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922034933 PECOS PAC ID: 8224942065 Enrollment ID: I20061201000305 |
| Provider Name | Stephanie Kimmes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215992706 PECOS PAC ID: 7416094180 Enrollment ID: I20091029000063 |
| Provider Name | Michelle S Christian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508921909 PECOS PAC ID: 3274790324 Enrollment ID: I20120201000875 |
| Provider Name | Emre Josiah Michelle Mauleon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528540671 PECOS PAC ID: 9739432782 Enrollment ID: I20181022002502 |
| Provider Name | Connie Gertz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760856165 PECOS PAC ID: 6507272747 Enrollment ID: I20210318000421 |
| Provider Name | Yvonne Wirsiy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366868861 PECOS PAC ID: 1355744871 Enrollment ID: I20210721003030 |
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