Healthcare Provider Details

I. General information

NPI: 1942047550
Provider Name (Legal Business Name): MICHAEL T NWANNA APRN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 TWELVE OAKS CENTER DR STE 217
WAYZATA MN
55391-4541
US

IV. Provider business mailing address

600 TWELVE OAKS CENTER DR STE 217
WAYZATA MN
55391-4541
US

V. Phone/Fax

Practice location:
  • Phone: 952-322-0768
  • Fax: 952-592-3941
Mailing address:
  • Phone: 952-322-0768
  • Fax: 952-592-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11786
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: