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General NPI Number Information
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NPI Number | 1811645856
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Entity Type | Organization
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Legal Business Name | AVLIAN MENTAL HEALTH CARE LLC
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 3936 E. FRONTAGE RD. HWY. 52 N PMB 182
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City | ROCHESTER
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State | MN
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Zip | 55901
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Country | US
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Telephone | 507-564-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 3936 E. FRONTAGE RD. HWY. 52 N PMB 182
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City | ROCHESTER
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State | MN
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Zip | 55901
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Country | US
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Telephone | 507-564-2050
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADONYE AFONYA
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Credential |
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Telephone | 507-564-2050
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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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