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3300 Fremont Ave N Minneapolis MN 55412-2405 | |
(612) 588-9411 | |
(612) 522-6627 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3300 Fremont Ave N, Minneapolis, Minnesota |
Authorized Official Name and Position | Steve J Knutson (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 6122872428 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3300 Fremont Ave N Minneapolis MN 55412-2405 Ph: (612) 588-9411 | 3300 Fremont Ave N Minneapolis MN 55412-2405 Ph: (612) 588-9411 |
NPI Number | 1386682078 |
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Provider Enumeration Date | 06/03/2006 |
Last Update Date | 06/29/2023 |
Medicare PECOS PAC ID | 9133199953 |
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Medicare Enrollment ID | O20040729000231 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386682078 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Emily E Benzie |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1326075821 PECOS PAC ID: 7618943515 Enrollment ID: I20040902000399 |
Provider Name | Robin J Bresette |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1194757419 PECOS PAC ID: 0941254072 Enrollment ID: I20050310000778 |
Provider Name | Mark M Vint |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1508835422 PECOS PAC ID: 5597771246 Enrollment ID: I20060303000668 |
Provider Name | Christina M Olson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1205945821 PECOS PAC ID: 1759559388 Enrollment ID: I20110726000143 |
Provider Name | Erin A Moeller |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1235589797 PECOS PAC ID: 8820367220 Enrollment ID: I20170628000705 |
Provider Name | Chelsea Elizabeth Dean Butay |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1376911347 PECOS PAC ID: 6103159975 Enrollment ID: I20190610002548 |
Provider Name | Patrice Danielle Dalton |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295374171 PECOS PAC ID: 4789010489 Enrollment ID: I20200128001764 |
Provider Name | Susanna Funk |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598019663 PECOS PAC ID: 9133373285 Enrollment ID: I20210812001878 |
Provider Name | Amina Adan Mohamed |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1144866336 PECOS PAC ID: 8123456720 Enrollment ID: I20220802003551 |
Provider Name | Kendal Ann Parette |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1255841573 PECOS PAC ID: 0244651396 Enrollment ID: I20220811000700 |
Provider Name | Christi A Desautels |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497529796 PECOS PAC ID: 5395193304 Enrollment ID: I20231201001745 |
Provider Name | Brianne Wallgren |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1083486468 PECOS PAC ID: 9830536457 Enrollment ID: I20240319001227 |
Provider Name | Olive Lewinski Albanese |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1396487021 PECOS PAC ID: 1951780832 Enrollment ID: I20241025001736 |
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