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Organization
FRIDLEY TARGET CLINIC
Active
Organization
FRIDLEY TARGET CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MILLICENT WANJOHI PA-C (PHYSICIAN ASSISTANT)
(763) 571-9361
Entity
Organization
Contact information
Practice address
755 53RD AVE NE, FRIDLEY, MN 55421-1240
(763) 571-9361
Mailing address
12375 OAK PARK BLVD NE, APT # 206, BLAINE, MN 55434-7302
(763) 862-9656
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
935
MN
Other
Enumeration date
10/27/2006
Last updated
08/22/2020
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