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General NPI Number Information
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NPI Number | 1225796071
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Entity Type | Organization
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Legal Business Name | LUX PSYCHIATRIC SERVICES
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Dates
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Enumeration Date | 11/29/2021
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 3800 AMERICAN BLVD W STE 1500
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City | BLOOMINGTON
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State | MN
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Zip | 55431-4429
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Country | US
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Telephone | 346-481-3421
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Fax | 502-385-6589
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Provider Business Mailing Address
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Address Line | 3800 AMERICAN BLVD W STE 1500
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City | BLOOMINGTON
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State | MN
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Zip | 55431-4429
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Country | US
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Telephone | 346-481-3421
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Fax | 502-385-6589
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | TASHA U OLADIPO
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Credential | MSN, APRN
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Telephone | 346-481-3421
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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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