Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Northern Lights Pediatric & Adolescent Medicine

Organization Pediatric Adolescent Medicine Physician · NPI 1912069519

Northern Lights Pediatric & Adolescent Medicine is a Pediatric Adolescent Medicine Physician in Vadnais Heights, Minnesota. Registered with an NPI since 2006.

In the registry since
2006

Practice location Address checks out

3555 Willow Lake Blvd Ste 140
Vadnais Heights, MN 55110-4462
Phone: (651) 251-5280
Fax: (651) 251-5282
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Adolescent Medicine Physician (primary) Taxonomy 2080A0000X

Record details

NPI number1912069519
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Wendy McCabe — Partner · (651) 251-5280
NPI enumeratedDecember 14, 2006
Last updated in NPPESMay 20, 2009
Mailing address3555 Willow Lake Blvd., Suite 140, Vadnais Heights, MN 55110-4462

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