Martha's Open Hands Pllc | |
7362 University Ave Ne Ste 310-3 Fridley MN 55432-3142 | |
(612) 567-9587 | |
(612) 682-1206 |
Full Name | Martha's Open Hands Pllc |
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Speciality | Clinic/Center |
Location | 7362 University Ave Ne Ste 310-3, Fridley, Minnesota |
Authorized Official Name and Position | Princess Gehyigon-wallace (OWNER) |
Authorized Official Contact | 7639138125 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Martha's Open Hands Pllc 7362 University Ave Ne Ste 310-3 Fridley MN 55432-3142 Ph: () - | Martha's Open Hands Pllc 7362 University Ave Ne Ste 310-3 Fridley MN 55432-3142 Ph: (612) 567-9587 |
NPI Number | 1235857673 |
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Provider Enumeration Date | 08/22/2022 |
Last Update Date | 11/08/2022 |
Medicare PECOS PAC ID | 6406224450 |
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Medicare Enrollment ID | O20221122002060 |
Identifier | Type | State | Issuer |
---|---|---|---|
1235857673 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Princess K Gehyigon-wallace |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1275190027 PECOS PAC ID: 4284968991 Enrollment ID: I20190701001256 |
Provider Name | Heduik Mah Cho-mofor |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1407533722 PECOS PAC ID: 6002259546 Enrollment ID: I20240212002159 |
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