| NPI | 1760293617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FELICIA C IKEBUDE Partner 612-267-0424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2025-01-18 |
| Last Update Date | 2025-04-14 |