Minnesota Wellcare LLC
Nurse Practitioner, Psych/Mental Health in Lakeville, MN. Organization (NPI-2).
NPI number1801548748
StatusActive
Last updated in NPPESMar 29, 2022
Details
- NPI
- 1801548748
- Entity type
- Organization (NPI-2)
- Legal business name
- Minnesota Wellcare LLC
- Organization subpart
- No
- Enumeration date
- Jan 21, 2022
- Certification date
- Mar 29, 2022
- Last updated
- Mar 29, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – | Yes |
| 261QM0850X | Clinic/Center, Adult Mental Health | – | – | |
| 261QM0855X | Clinic/Center, Adolescent and Children Mental Health | – | – |
Practice location
10519 165th St WLakeville, MN 55044-5722
Phone 952-248-2719
Mailing address
10519 165th St WLakeville, MN 55044-5722
Phone 952-248-2719
Authorized official
Katie Kocina
Executive Director
9522482719
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