Provider Demographics
NPI:1326064908
Name:NSU INC
Entity Type:Organization
Organization Name:NSU INC
Other - Org Name:CORNERSTONE HEALTHCARE OF WINONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TESSIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RENARD
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:507-474-4770
Mailing Address - Street 1:170 E 4TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3512
Mailing Address - Country:US
Mailing Address - Phone:507-474-4770
Mailing Address - Fax:507-474-4774
Practice Address - Street 1:62 E 3RD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3481
Practice Address - Country:US
Practice Address - Phone:507-474-4770
Practice Address - Fax:507-474-4774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN109960OtherHEALTH PARTNERS
MN677G2COOtherBCBS MN
MNDE4827Medicare ID - Type UnspecifiedRR MEDICARE
MN109960OtherHEALTH PARTNERS