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1115 E Main St Albert Lea MN 56007-3600 | |
| (507) 676-3153 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1115 E Main St, Albert Lea, Minnesota |
| Authorized Official Name and Position | Jennifer May Wood (PRESIDENT) |
| Authorized Official Contact | 5076763153 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1601 Sunset St Albert Lea MN 56007-1575 Ph: (507) 676-3153 | 1115 E Main St Albert Lea MN 56007-3600 Ph: (507) 676-3153 |
| NPI Number | 1538996814 |
|---|---|
| Provider Enumeration Date | 09/19/2024 |
| Last Update Date | 10/25/2024 |
| Medicare PECOS PAC ID | 9032644240 |
|---|---|
| Medicare Enrollment ID | O20241125003692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538996814 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Jennifer M Wood |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1548438153 PECOS PAC ID: 5799842068 Enrollment ID: I20241125003841 |
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