Provider Demographics
NPI:1548235880
Name:GILLIKSEN, LORENE K (CNM)
Entity Type:Individual
Prefix:
First Name:LORENE
Middle Name:K
Last Name:GILLIKSEN
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Gender:F
Credentials:CNM
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:MAIL STOP 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5463
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:8450 SEASONS PKWY
Practice Address - Street 2:MAIL STOP 32300A
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4402
Practice Address - Country:US
Practice Address - Phone:651-702-5300
Practice Address - Fax:651-702-5305
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN0786586367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
S22255Medicare UPIN