Graduated: 2024
NPI: 1720806490
Practice Locations (2)
CENTRACARE CLINIC
1555 NORTHWAY DR, 100 CENTRA CARE CLINIC NORTHWAY FAMILY
ST CLOUD, MN 563031258
3202511775
ST CLOUD HOSPITAL
1555 NORTHWAY DR, 200 CENTRA CARE FAMILY HEALTH CENTER
ST CLOUD, MN 563034913
3202403157
Source: CMS National Downloadable File, September 2026.