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General NPI Number Information
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NPI Number | 1013827245
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Entity Type | Organization
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Legal Business Name | MIND REVITALIZED PSYCHIATRY PLLC
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 7420 UNITY AVE N STE 307B
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City | BROOKLYN PARK
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State | MN
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Zip | 55443-3136
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Country | US
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Telephone | 609-338-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 7420 UNITY AVE N STE 307B
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City | BROOKLYN PARK
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State | MN
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Zip | 55443-3136
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Country | US
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Telephone | 609-338-4325
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Fax |
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Authorized Official
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Title or Position | MEMBER-MANAGER
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Name | ABENA V PREMPEH
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Credential | DNP, PMHNP-BC
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Telephone | 609-338-4325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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