Healthcare Provider Details

I. General information

NPI: 1316883473
Provider Name (Legal Business Name): NORTHMIND WELLNESS PLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31283 FRONT ST
PEQUOT LAKES MN
56472-2632
US

IV. Provider business mailing address

31283 FRONT ST
PEQUOT LAKES MN
56472-2632
US

V. Phone/Fax

Practice location:
  • Phone: 218-822-1008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: NIKKITA LEE DINNELLA
Title or Position: CO-OWNER/PMHNP-BC
Credential: PMHNP-BC
Phone: 218-822-1008