Healthcare Provider Details

I. General information

NPI: 1619490893
Provider Name (Legal Business Name): MEWINZHA ONDAADIZIIKE WIIGAMING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 PAUL BUNYAN DR S STE 12&13
BEMIDJI MN
56601-3201
US

IV. Provider business mailing address

802 PAUL BUNYAN DR S STE 12
BEMIDJI MN
56601-3204
US

V. Phone/Fax

Practice location:
  • Phone: 218-444-4323
  • Fax: 218-444-7514
Mailing address:
  • Phone: 218-444-4323
  • Fax: 218-444-7514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberR-158189-0
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberR-158189-0
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR-158189-0
License Number StateMN
# 8
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMN
# 9
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR-158189-0
License Number StateMN

VIII. Authorized Official

Name: MILLICENT SIMENSON
Title or Position: FOUNDER/PRESIDENT
Credential: LPN
Phone: 218-556-1961