Organization
INSIGHT CARE P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BOONE PHOUTHAVANE (OPERATIONS MANAGER)
(612) 250-0263
Entity
Organization
Contact information
Practice address
620 CIVIC HEIGHTS DR STE 109, CIRCLE PINES, MN 55014-4709
(612) 321-8085
Mailing address
11660 THEATRE DR N STE 270, CHAMPLIN, MN 55316-4527
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R190679-2
MN
Other
Enumeration date
01/31/2018
Last updated
01/31/2018
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