| Resilient Fusion | |
|
3662 Pointe Pass Nw Prior Lake MN 55372-4555 | |
| (952) 210-2724 | |
| Not Available |
| Full Name | Resilient Fusion |
|---|---|
| Speciality | Clinic/Center |
| Location | 3662 Pointe Pass Nw, Prior Lake, Minnesota |
| Authorized Official Name and Position | Latasha Peterson (OWNER) |
| Authorized Official Contact | 9522102724 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Resilient Fusion 3662 Pointe Pass Nw Prior Lake MN 55372-4555 Ph: (952) 210-2724 | Resilient Fusion 3662 Pointe Pass Nw Prior Lake MN 55372-4555 Ph: (952) 210-2724 |
| NPI Number | 1063264612 |
|---|---|
| Provider Enumeration Date | 04/04/2024 |
| Last Update Date | 04/04/2024 |
| Certification Date | 04/04/2024 |
| Medicare PECOS PAC ID | 0840632766 |
|---|---|
| Medicare Enrollment ID | O20240523002255 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063264612 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Latasha Peterson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598169484 PECOS PAC ID: 3274970967 Enrollment ID: I20240318000506 |
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