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General NPI Number Information
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NPI Number | 1770081176
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Entity Type | Organization
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Legal Business Name | INSIGHT CARE P.A.
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 620 CIVIC HEIGHTS DR STE 109
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City | CIRCLE PINES
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State | MN
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Zip | 55014-4709
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Country | US
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Telephone | 612-321-8085
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Fax |
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Provider Business Mailing Address
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Address Line | 11660 THEATRE DR N STE 270
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City | CHAMPLIN
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State | MN
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Zip | 55316-4527
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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 | OPERATIONS MANAGER
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Name | MR. BOONE PHOUTHAVANE
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Credential |
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Telephone | 612-250-0263
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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 | R190679-2
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License Number State | MN
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