Healthcare Provider Details

I. General information

NPI: 1407620453
Provider Name (Legal Business Name): WISE MINDS BY RHEA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 S POKEGAMA AVE UNIT 11
GRAND RAPIDS MN
55744-4208
US

IV. Provider business mailing address

1255 S POKEGAMA AVE UNIT 11
GRAND RAPIDS MN
55744-4208
US

V. Phone/Fax

Practice location:
  • Phone: 218-999-0018
  • Fax: 218-999-9627
Mailing address:
  • Phone: 218-999-0018
  • Fax: 218-999-9627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RHEA LOU DEL ROSARIO
Title or Position: CEO, PMHNP
Credential: PMHNP
Phone: 218-999-0018