| NPI | 1184474504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MILLICENT BOA-AMPONSEM Director 612-552-1748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2024-03-26 |
| Last Update Date | 2024-03-26 |