Graduated: 2024
NPI: 1679317614
Practice Locations (3)
PARK NICOLLET CLINIC
5320 HYLAND GREENS DR
BLOOMINGTON, MN 554373934
9529932400
PARK NICOLLET CLINIC
15301 GROVE CIR N
MAPLE GROVE, MN 553694475
9529935900
ACTIVEPT, CORP.
3708 BROADWAY AVE N, SUITE 110
ROCHESTER, MN 559064159
5073223460
Source: CMS National Downloadable File, September 2026.