Healthcare Provider Details

I. General information

NPI: 1588347181
Provider Name (Legal Business Name): ESTHER ACHIE NJINGU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 05/02/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DIAMOND LAKE CLINIC 5939 PORTLAND AVENUE
MINNEAPOLIS MN
55417
US

IV. Provider business mailing address

13934 ASHFORD PATH
ROSEMOUNT MN
55068-3923
US

V. Phone/Fax

Practice location:
  • Phone: 612-869-4444
  • Fax:
Mailing address:
  • Phone: 612-239-0276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10302
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: