Provider Demographics
NPI:1699428292
Name:NIGHTINGALE CLINICAL CONSULTANTS
Entity type:Organization
Organization Name:NIGHTINGALE CLINICAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WACHTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-283-5183
Mailing Address - Street 1:1749 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6129
Mailing Address - Country:US
Mailing Address - Phone:651-283-5183
Mailing Address - Fax:
Practice Address - Street 1:275 3RD ST S STE 103
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-8000
Practice Address - Country:US
Practice Address - Phone:651-283-5183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty