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General NPI Number Information
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NPI Number | 1639034770
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Entity Type | Organization
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Legal Business Name | RESONANCEBRIDGE PSYCHIATRY & WELLNESS
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Dates
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Enumeration Date | 12/20/2025
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Last Update Date | 12/20/2025
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Provider Practice Location Address
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Address Line | 12682 88TH AVE N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-3044
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Country | US
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Telephone | 605-381-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 12800 WHITEWATER DR STE 100
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City | MINNETONKA
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State | MN
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Zip | 55343-9347
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | JOHNTHAP OBAKPOLOR
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Credential | APRN
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Telephone | 605-381-3339
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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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