Graduated: 2020
NPI: 1366034514
Practice Locations (3)
PARK NICOLLET CLINIC
5320 HYLAND GREENS DR
BLOOMINGTON, MN 554373934
9529932400
GROUP HEALTH PLAN INC
640 JACKSON ST
SAINT PAUL, MN 551012502
6512544786
PARK NICOLLET CLINIC
6500 EXCELSIOR BLVD
ST LOUIS PARK, MN 554264702
9529933123
Source: CMS National Downloadable File, September 2026.