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General NPI Number Information
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NPI Number | 1710783436
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Entity Type | Organization
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Legal Business Name | DESIRE WELLNESS CARE
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Dates
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Enumeration Date | 02/22/2025
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Last Update Date | 02/22/2025
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Provider Practice Location Address
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Address Line | 6935 74TH ST S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-4468
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Country | US
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Telephone | 612-250-1088
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Fax |
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Provider Business Mailing Address
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Address Line | 6935 74TH ST S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-4468
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Country | US
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Telephone | 612-250-1088
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | IJEOMA NWIWUZO OGBONNAYA
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Credential | PMHNP-BC, CNP
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Telephone | 612-250-1088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family 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 | 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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