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Organization
MINNESOTA WELLCARE LLC
Active
Organization
MINNESOTA WELLCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATIE KOCINA (EXECUTIVE DIRECTOR)
(952) 248-2719
Entity
Organization
Contact information
Practice address
10519 165TH ST W, LAKEVILLE, MN 55044-5722
(952) 248-2719
Mailing address
10519 165TH ST W, LAKEVILLE, MN 55044-5722
(952) 248-2719
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/21/2022
Last updated
03/29/2022
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