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NPI 1679348247 · Psychiatric/Mental Health Nurse Practitioner · Spring Lake Park, MN
Provider details
- NPI number
- 1679348247
- Entity type
- Individual
- Primary specialty
- Psychiatric/Mental Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Sex
- Male
- Sole proprietor
- No
- License
- 10993 (MN)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
8340 5th St Ne
Spring Lake Park, MN 55432-1135
Phone: (612) 886-5439
Approximate (ZIP-level) locationGet directions
Mailing address
8340 5th St Ne
Spring Lake Park, MN 55432-1135
Registry dates
- Enumerated
- 2023-11-23
- Last updated
- 2023-11-23
- Certified
- 2023-11-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.