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SELAH WELLNESS CLINIC LLC
NPI 1104513126
Nurse Practitioner in Pine City, MN

Active since April 19, 2023CLIA 24D2313654 · Waiver
1300 NORTHRIDGE CT NW, PINE CITY, MN 55063(320) 372-2323 Get Directions Write a Review

NPPES record last updated: May 31, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 31, 2026, Jan 4, 2026 (2 updates tracked since 2026).

About Selah Wellness Clinic Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SELAH WELLNESS CLINIC LLC (NPI 1104513126) is a healthcare organization registered as a nurse practitioner in Pine City, Minnesota and active in the NPI registry since April 2023. The organization holds a CLIA Waiver certificate valid through November 4, 2026 and lists Tina Keller, Vp Compliance, as its authorized official.

NPPES Registry Identity

NPI1104513126
Entity TypeOrganization
Primary Taxonomy363L00000X
Legal Business NameSELAH WELLNESS CLINIC LLC
Location Address1300 NORTHRIDGE CT NWPine City, MN 55063-5821
Mailing Address501 Main StSandstone, MN 55072-4410 · (320) 372-2323
Phone(320) 372-2323
Organization SubpartNo
Authorized OfficialTina KellerVp Compliance · (320) 372-2323
Enumeration DateApril 19, 2023
Last NPPES UpdateMay 31, 20262 updates tracked since enumeration
NPPES CertifiedMay 31, 2026
✔ NPI 1104513126 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
1300 NORTHRIDGE CT NW, Pine City, MN 55063
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Medica, Sanford Health Plan.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D2313654

Selah Wellness Clinic LLC · Pine City, MN
Active · expires Nov 4, 2026
CLIA Number24D2313654
Laboratory TypePractitioner Other
Certificate Effective DateNovember 5, 2024
Certificate Expiration DateNovember 4, 2026
Laboratory DirectorNaomi J. Koenig
Laboratory Phone(320) 372-2323
Laboratory LocationSelah Wellness Clinic LLC1300 Northridge Dr NW, Pine City, MN 55063
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 24D2264180

Selah Wellness Clinic LLC · Sandstone, MN
Expired · Jul 11, 2026
CLIA Number24D2264180
Laboratory TypePractitioner Other
Certificate Effective DateJuly 12, 2024
Certificate Expiration DateJuly 11, 2026
Laboratory DirectorNaomi J. Koenig
Laboratory Phone(320) 372-2323
Laboratory LocationSelah Wellness Clinic LLC501 Main Street, Sandstone, MN 55072
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Selah Wellness Clinic LLC's NPI number?

The NPI number for Selah Wellness Clinic LLC is 1104513126. It was assigned to this organization in the NPPES registry on April 19, 2023.

Where is Selah Wellness Clinic LLC located?

Selah Wellness Clinic LLC is located at 1300 Northridge Ct NW, Pine City, MN 55063. The listed phone number is (320) 372-2323.

What is Selah Wellness Clinic LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Does Selah Wellness Clinic LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2313654) is associated with this NPI, valid through November 4, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Selah Wellness Clinic LLC accept?

Health plans from Medica and Sanford Health Plan list Selah Wellness Clinic LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Selah Wellness Clinic LLC was last updated on May 31, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.