Integrative Geriatrics, PLLC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

Legal business name

INTEGRATIVE GERIATRICS, PLLC

Practice address

21897 S Diamond Lake Rd Ste 400-403
Rogers, MN 55374-4642

Phone

(763) 317-1122

NPI assigned

Jul 3, 2017

Organization subpart

No

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

Authorized official

Name

Rebecca Ahlstrom, APRN, CNP

Title

Nurse Pracitioner/Owner

Phone

(612) 308-2162

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1499040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630368000000",
    "number": "1932620796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21897 S DIAMOND LAKE RD STE 400-403",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553744642",
            "telephone_number": "763-317-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21897 S DIAMOND LAKE RD STE 400-403",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553744642",
            "telephone_number": "763-317-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE GERIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-03",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A",
        "authorized_official_last_name": "AHLSTROM",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "NURSE PRACITIONER/OWNER",
        "authorized_official_telephone_number": "612-308-2162",
        "authorized_official_credential": "APRN, CNP"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Nurse Practitioner in Rogers, MN
• Providers in Rogers, MN by specialty
• Gerontology Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; 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.