| NPI | 1891586582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AGNES LIMUNGA JACKAI Nurse Practitioner 612-598-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-05-13 |
| Last Update Date | 2025-07-31 |