Provider Demographics
NPI:1982882742
Name:NUCLEUS CLINIC
Entity Type:Organization
Organization Name:NUCLEUS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:763-755-5300
Mailing Address - Street 1:1323 COON RAPIDS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5362
Mailing Address - Country:US
Mailing Address - Phone:763-755-5300
Mailing Address - Fax:763-755-5301
Practice Address - Street 1:1323 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5362
Practice Address - Country:US
Practice Address - Phone:763-755-5300
Practice Address - Fax:763-755-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare