Provider Demographics
NPI:1609614668
Name:OUTPATIENT PSYCHIATRY
Entity type:Organization
Organization Name:OUTPATIENT PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:SHURI
Authorized Official - Middle Name:LOVEINE
Authorized Official - Last Name:NWUNASI
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONERS
Authorized Official - Phone:651-307-4396
Mailing Address - Street 1:7420 UNITY AVE N STE 205D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3166
Mailing Address - Country:US
Mailing Address - Phone:651-307-4396
Mailing Address - Fax:
Practice Address - Street 1:7420 UNITY AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3143
Practice Address - Country:US
Practice Address - Phone:651-307-4396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty