1316445455 NPI number — NORTHERN WATERS CLINIC

Table of content: DR. PAULA ANDREA ADUEN PHD (NPI 1093291684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316445455 NPI number — NORTHERN WATERS CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN WATERS CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316445455
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1702 MILLER TRUNK HWY STE 214
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55811-4448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4899 MILLER TRUNK HWY STE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMANTOWN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55811-1582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-391-9860
Provider Business Practice Location Address Fax Number:
218-391-9860
Provider Enumeration Date:
01/23/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAKI
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
218-727-3888

Provider Taxonomy Codes

  • Taxonomy code: 163WP0808X , with the licence number:  2318 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0807X , with the licence number: 2318 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1295014520 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".