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General NPI Number Information
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NPI Number | 1356020556
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Entity Type | Organization
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Legal Business Name | IDEAL PERCEPTION MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 07/14/2023
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 2658 BRITTANY LN
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City | WOODBURY
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State | MN
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Zip | 55125-3017
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Country | US
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Telephone | 651-795-9209
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Fax |
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Provider Business Mailing Address
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Address Line | 2658 BRITTANY LN
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City | WOODBURY
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State | MN
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Zip | 55125-3017
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Country | US
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Telephone | 651-795-9209
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | OGECHUKWU LINDA UGWU
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Credential | CNP
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Telephone | 651-795-9209
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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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