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General NPI Number Information
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NPI Number | 1023909595
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE HEALTH & WELLNESS CLINIC
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 8421 W BROADWAY AVE
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City | BROOKLYN PARK
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State | MN
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Zip | 55445-2266
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Country | US
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Telephone | 763-213-9359
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Fax |
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Provider Business Mailing Address
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Address Line | 8421 W BROADWAY AVE
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City | BROOKLYN PARK
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State | MN
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Zip | 55445-2266
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Country | US
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Telephone | 763-213-9359
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Fax |
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Authorized Official
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Title or Position | APRN
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Name | STELLA NYAKUNDI
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Credential |
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Telephone | 763-213-9359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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