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WATERSIDE HEALTHCARE & WELLNESS, LLC
NPI 1780223743
Nurse Practitioner - Family in Waconia, MN

Active since December 22, 2019CLIA 24D2181217 · 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 02, 2026.

About Waterside Healthcare & Wellness, Llc NPPES

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

WATERSIDE HEALTHCARE & WELLNESS, LLC (NPI 1780223743) is a healthcare organization registered as a family in Waconia, Minnesota and active in the NPI registry since December 2019. The organization holds a CLIA Waiver certificate valid through March 29, 2028 and lists Nicole M Siddons, Owner Of Entity, as its authorized official.

NPPES Registry Identity

NPI1780223743
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameWATERSIDE HEALTHCARE & WELLNESS, 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 SiddonsOwner Of Entity · (920) 217-9035
Enumeration DateDecember 22, 2019
✔ NPI 1780223743 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
212 W LAKE ST, Waconia, MN 55387
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 24D2181217

Waterside Healthcare & Wellness LLC · Waconia, MN
Active · expires Mar 29, 2028
CLIA Number24D2181217
Laboratory TypeMobile Urgent & Primary C
Certificate Effective DateMarch 30, 2026
Certificate Expiration DateMarch 29, 2028
Laboratory DirectorNicole M. Siddons
Laboratory Phone(920) 217-9035
Laboratory LocationWaterside Healthcare & Wellness LLC212 W Lake St, Waconia, MN 55387
CLIA data matches this NPI record on: Address Name Phone
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)
212 W LAKE ST
WACONIA, MN 55387
Carver County (763) 232-1209
DR. UCHE FRANKLIN DNP, APRN, CNP, FNP
Nurse Practitioner (Family)
212 W LAKE ST
WACONIA, MN 55387
Carver County (651) 603-4565
NORTHERN LIGHTS HEALTH LLC
Nurse Practitioner (Primary Care)
212 W LAKE ST
WACONIA, MN 55387
Carver County (920) 217-9035
JOEY ROCHELLE MITCHELL
Nurse Practitioner (Adult Health)
212 W LAKE ST
WACONIA, MN 55387
Carver County (456) 565-1603
MRS. MELISSA ANN HILL FNP
Nurse Practitioner (Family)
212 W LAKE ST
WACONIA, MN 55387
Carver County (651) 603-4565

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 Waterside Healthcare & Wellness, LLC's NPI number?

The NPI number for Waterside Healthcare & Wellness, LLC is 1780223743. It was assigned to this organization in the NPPES registry on December 22, 2019.

Where is Waterside Healthcare & Wellness, LLC located?

Waterside Healthcare & Wellness, LLC is located at 212 W Lake St, Waconia, MN 55387. The listed phone number is (920) 217-9035.

What is Waterside Healthcare & Wellness, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Does Waterside Healthcare & Wellness, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2181217) is associated with this NPI, valid through March 29, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Waterside Healthcare & Wellness, LLC was last updated on December 22, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years 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.