| NPI | 1841916525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAOLAE J JONES Nurse Practitioner 763-464-9784 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2022-10-14 |
| Last Update Date | 2022-10-14 |