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Organization
WISDOM PSYCHIATRIC CARE AND MEDICATION MANAGEMENT LLC
Active
Organization
WISDOM PSYCHIATRIC CARE AND MEDICATION MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELODIE ANNE KABANUK DOHM APRN-CNP, PMHNP (OWNER/PROVIDER)
(320) 232-0647
Entity
Organization
Contact information
Practice address
2704 MOUNDS VIEW BLVD, STE 12, MOUNDS VIEW, MN 55112
(320) 232-0647
(567) 205-3614
Mailing address
8628 HASTINGS ST NE, BLAINE, MN 55449-4252
(320) 232-0647
(567) 205-3614
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
359498100
—
MN
Enumeration date
02/23/2021
Last updated
02/17/2022
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