| NPI | 1467201301 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EKAN EKONG Pmhnp Bc 763-498-4448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-05-14 |
| Last Update Date | 2024-10-21 |