Provider Demographics
NPI:1497265995
Name:MY LEGAL NURSE CONSULTANTS LLC
Entity Type:Organization
Organization Name:MY LEGAL NURSE CONSULTANTS LLC
Other - Org Name:MANDA'S HOUSE ST. CLOUD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROMANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAYE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:763-744-6192
Mailing Address - Street 1:10608 ARROWHEAD ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4013
Mailing Address - Country:US
Mailing Address - Phone:763-744-6192
Mailing Address - Fax:
Practice Address - Street 1:2607 15TH AVE SE
Practice Address - Street 2:
Practice Address - City:ST. CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304
Practice Address - Country:US
Practice Address - Phone:763-744-6192
Practice Address - Fax:320-251-1486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1813283163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty