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Organization

THE MINNESOTA KETAMINE AND WELLNESS INSTITUTE PA

Active
Other names
The Minnesota Ketamine and Wellness Institue, P.A., The Minnesota and Ketamine Wellness Institute
Organization subpart
No

Provider details

NPI number
Authorized official
CHRISTENA REGENA HATCHER CRNA (CFO)
(612) 394-8717
Entity
Organization

Contact information

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

Taxonomy

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

Other

Enumeration date
02/03/2021
Last updated
08/20/2021
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