MEDICARE: EMPOWER WELLNESS PSYCHIATRIC & MANAGEMENT P. L. L. C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1013862564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWER WELLNESS PSYCHIATRIC & MANAGEMENT P. L. L. C.

Provider Business Mailing Address
First Line	:	2104 PARK AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-6607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2104 PARK AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-6607
Country	:	US
Telephone Number	:	763-732-2080
Fax Number	:

Authorized Official
Title or Position	:	PMHNP
Name	:	EMMACULATE BIH AWASOM
Credential	:	PMHNP
Telephone Number	:	763-732-2080

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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