Provider Demographics
NPI:1073358172
Name:WOMEN'S VITALITY & FERTILITY PLLC
Entity type:Organization
Organization Name:WOMEN'S VITALITY & FERTILITY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHLINE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:507-456-9279
Mailing Address - Street 1:120 NIGHTHAWK LN
Mailing Address - Street 2:
Mailing Address - City:MADISON LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56063-5001
Mailing Address - Country:US
Mailing Address - Phone:507-456-9279
Mailing Address - Fax:949-695-4869
Practice Address - Street 1:125 SAINT ANDREWS CT STE 221
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-8600
Practice Address - Country:US
Practice Address - Phone:507-519-0370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care