West Central Neurology PA

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

33547 Issued in MN

Legal business name

WEST CENTRAL NEUROLOGY PA

Practice address

11521 312TH Ave
Princeton, MN 55371-3423

Phone

(763) 389-4910

NPI assigned

Nov 20, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lawrence John Jedlicka, MD

Title

President

Phone

(907) 290-6355

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542585600000",
    "number": "1720233570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110614",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995110614",
            "telephone_number": "763-389-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11521 312TH AVE",
            "city": "PRINCETON",
            "state": "MN",
            "postal_code": "553713423",
            "telephone_number": "763-389-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST CENTRAL NEUROLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-20",
        "last_updated": "2018-11-19",
        "status": "A",
        "authorized_official_last_name": "JEDLICKA",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-290-6355",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MN",
            "license": "33547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores Inc (Wal-Mart Vision Center30-3102)
• David A Waletzko, MD
• Walmart Inc. (WalMart Pharmacy 10-3102)
• Mary Frances Ward, MA: CCC
• Maria Jeanne Werner, C.M.T.
• Kynan Richard Westermeyer, DDS
• White Birch Dental, PLLC
• Jocelyn Wiedewitsch
• Lucas Burton Winskowski, LADC
• Barbara Lynn Wisniewski, LPCC

• Neurology Physician in Princeton, MN
• Providers in Princeton, MN by specialty
• Neurology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.