# THE MINNESOTA KETAMINE AND WELLNESS INSTITUTE PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Minnesota Ketamine and Wellness Institue, P.A., The Minnesota and Ketamine Wellness Institute
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003408857
- **Authorized official:** CHRISTENA REGENA HATCHER CRNA (CFO)
- **Authorized official phone:** (612) 394-8717

## Contact information

- **Practice address:** 9325 UPLAND LN N STE 370, MAPLE GROVE, MN 55369-4463
- **Practice address phone:** (612) 394-8717
- **Practice address fax:** (763) 432-5721
- **Mailing address:** 9325 UPLAND LN N STE 370, MAPLE GROVE, MN 55369-4463
- **Mailing address phone:** (612) 394-8717
- **Mailing address fax:** (763) 432-5721

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 261QI0500X | Infusion Therapy Clinic/Center | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 02/03/2021
- **Last updated:** 08/20/2021