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General NPI Number Information
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NPI Number | 1417528043
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Entity Type | Organization
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Legal Business Name | MISSION WELLNESS MN PLLC
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 6636 CEDAR AVE S STE 380
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City | RICHFIELD
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State | MN
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Zip | 55423-2712
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Country | US
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Telephone | 612-271-6807
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Fax | 844-703-6539
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Provider Business Mailing Address
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Address Line | 3315 MONDAMIN ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55417-2056
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Country | US
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Telephone | 612-703-6539
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Fax | 844-703-6539
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MICHELLE MURPHY
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Credential | CNP
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Telephone | 612-271-6807
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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 |
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License Number State |
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