Provider Demographics
NPI:1730168048
Name:PLANNED PARENTHOOD MINNESOTA, NORTH DAKOTA, SOUTH DAKOTA
Entity type:Organization
Organization Name:PLANNED PARENTHOOD MINNESOTA, NORTH DAKOTA, SOUTH DAKOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, REVENUE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-696-5676
Mailing Address - Street 1:PO BOX 64393
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55164-0393
Mailing Address - Country:US
Mailing Address - Phone:651-696-5676
Mailing Address - Fax:
Practice Address - Street 1:803 BELSLY BLVD
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5057
Practice Address - Country:US
Practice Address - Phone:218-236-7145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN417253100Medicaid