NORTHERN LIGHTS HEALTH LLC
NPI 1316581440
Nurse Practitioner - Primary Care in Waconia, MN

Q: What is Northern Lights Health LLC's NPI number?

The NPI number for Northern Lights Health LLC is 1316581440. It was assigned to this organization in the NPPES registry on October 31, 2019.

Q: What is Northern Lights Health LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Active since October 31, 2019CLIA 24D2199463 · Waiver

212 W LAKE ST, WACONIA, MN 55387(920) 217-9035 Get Directions Write a Review

NPPES record last updated: December 22, 2019. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Dec 22, 2019, Oct 31, 2019 (2 updates tracked since 2019).

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About Northern Lights Health Llc NPPES

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

NORTHERN LIGHTS HEALTH LLC (NPI 1316581440) is a healthcare organization registered as a primary care in Waconia, Minnesota and active in the NPI registry since October 2019. The organization holds a CLIA Waiver certificate valid through November 8, 2026 and lists Nicole M Siddons, Co-founder, as its authorized official.

NPPES Registry Identity

NPI1316581440

Entity TypeOrganization

Primary Taxonomy363LP2300X

Legal Business NameNORTHERN LIGHTS HEALTH LLC

Location Address212 W LAKE STWaconia, MN 55387-1014

Mailing Address212 W Lake StWaconia, MN 55387-1014 · (920) 217-9035

Phone(920) 217-9035

Organization SubpartNo

Authorized OfficialNicole M SiddonsCo-founder · (920) 217-9035

Enumeration DateOctober 31, 2019

Last NPPES UpdateDecember 22, 20192 updates tracked since enumeration

✔ NPI 1316581440 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP2300X

Also ListedNurse Practitioner · Acute CareTaxonomy 363LA2100X

Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X

Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X

Also ListedNurse Practitioner · GerontologyTaxonomy 363LG0600X

212 W LAKE ST, Waconia, MN 55387

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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 Anthem Blue Cross and Blue Shield, Medica.Insurance ›

CLIA Laboratory Certificates CMS CLIA

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 24D2199463

Northern Lights Health · Waconia, MN

Active · expires Nov 8, 2026

CLIA Number24D2199463

Laboratory TypeMobile Laboratory

Certificate Effective DateNovember 9, 2024

Certificate Expiration DateNovember 8, 2026

Laboratory DirectorTiffany J. Radke

Laboratory Phone(651) 603-4565

Laboratory LocationNorthern Lights Health212 W Lake Street, Waconia, MN 55387

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SEAN DEANE LEJONVARN CNP

Nurse Practitioner (Family)