Provider Demographics
NPI:1780426643
Name:WILLOW HEALTH, PLLC
Entity type:Organization
Organization Name:WILLOW HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:SAMANTHA
Authorized Official - Last Name:LINDEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-445-2692
Mailing Address - Street 1:4133 30TH AVE S STE 103
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8421
Mailing Address - Country:US
Mailing Address - Phone:701-658-5577
Mailing Address - Fax:701-888-5595
Practice Address - Street 1:4133 30TH AVE S STE 103
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8421
Practice Address - Country:US
Practice Address - Phone:701-658-5577
Practice Address - Fax:701-888-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty