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General NPI Number Information
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NPI Number | 1386896744
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Entity Type | Organization
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Legal Business Name | GERMANSON MD PSYCHIATRY LTD
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 13911 RIDGEDALE DRIVE SUITE 320
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City | MINNETONKA
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State | MN
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Zip | 55305
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Country | US
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Telephone | 952-956-4057
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Fax | 952-333-8196
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Provider Business Mailing Address
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Address Line | 1161 WAYZATA BLVD E #228
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City | WAYZATA
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State | MN
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Zip | 55391-1935
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Country | US
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Telephone | 952-956-4057
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Fax | 952-333-8196
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Authorized Official
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Title or Position | OWNER
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Name | DR. TWILA BAUER GERMANSON
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Credential | MD
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Telephone | 952-956-4057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 43294
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License Number State | MN
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