Organization
KETAMINE WELLNESS CENTERS MINNESOTA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANITA D JERGER (EXECUTIVE ASSISTANT)
(855) 538-9355
Entity
Organization
Contact information
Practice address
11995 COUNTY ROAD 11 STE 220, BURNSVILLE, MN 55337-5102
(855) 538-9355
(844) 538-9355
Mailing address
11995 COUNTY ROAD 11 STE 220, BURNSVILLE, MN 55337-5102
(855) 538-9355
(844) 538-9355
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
207L00000X
Anesthesiology Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
06/19/2019
Last updated
08/21/2020
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