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General NPI Number Information
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NPI Number | 1639531353
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Entity Type | Organization
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Legal Business Name | JOURNI LLC
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 277 COON RAPIDS BLVD SUITE 308
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City | COON RAPIDS
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State | MN
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Zip | 55433
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Country | US
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Telephone | 612-567-0981
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Fax |
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Provider Business Mailing Address
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Address Line | 11301 CROOKED LAKE BLVD
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City | COON RAPIDS
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State | MN
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Zip | 55433
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Country | US
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Telephone | 763-333-4718
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | TAMERA GRAZIANO
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Credential | ARNP
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Telephone | 763-333-4718
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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 | R217553-5
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License Number State | MN
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