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General NPI Number Information
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NPI Number | 1497640684
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Entity Type | Organization
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Legal Business Name | THREE BIRDS HEALTHCARE
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 3115 HENNEPIN AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2620
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Country | US
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Telephone | 612-405-9101
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 KIPLING AVE
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-4817
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Country | US
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Telephone | 612-405-9101
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KRISTA MARIE JOHNSON
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Credential | APRN
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Telephone | 612-405-9101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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