=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700769437
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAGNOLIA CIRCLE WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2025
-----------------------------------------------------
Last Update Date | 07/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1302 FREEDOM LN
-----------------------------------------------------
City | DELANO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55328-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-297-5236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1302 FREEDOM LN
-----------------------------------------------------
City | DELANO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55328-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-297-5236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OWNER
-----------------------------------------------------
Name | AMABELLE EQUIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 952-297-5236
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------