Individual
JACKLINE MONYANGI MORIASI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, PMHNP-BC
Contact information
Practice address
6200 SHINGLE CREEK PKWY STE 350, BROOKLYN CENTER, MN 55430-2155
(763) 503-8560
(763) 503-8563
Mailing address
4240 PARK GLEN RD, ST LOUIS PARK, MN 55416-5427
(612) 925-6033
(612) 925-8496
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1699478
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10108
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
RN312890
GA
Other
Enumeration date
09/20/2022
Last updated
06/22/2023
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