Provider Demographics
NPI:1699397851
Name:SCHOOL OF HEALTH LLC
Entity Type:Organization
Organization Name:SCHOOL OF HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:EGLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:OTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:651-808-2640
Mailing Address - Street 1:30165 TERRYLL ST
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-9310
Mailing Address - Country:US
Mailing Address - Phone:651-808-2640
Mailing Address - Fax:
Practice Address - Street 1:30165 TERRYLL ST
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-9310
Practice Address - Country:US
Practice Address - Phone:651-808-2640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty