Provider Demographics
NPI:1073134284
Name:PATHWAY VIRTU-HEALTH
Entity Type:Organization
Organization Name:PATHWAY VIRTU-HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TEMITOPE
Authorized Official - Middle Name:ABIOLA
Authorized Official - Last Name:DAWODU
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP, PMHNP-BC
Authorized Official - Phone:612-517-1293
Mailing Address - Street 1:4570 CHURCHILL ST STE 140
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-2274
Mailing Address - Country:US
Mailing Address - Phone:612-517-1293
Mailing Address - Fax:
Practice Address - Street 1:4570 CHURCHILL ST STE 140
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-2274
Practice Address - Country:US
Practice Address - Phone:612-517-1293
Practice Address - Fax:612-349-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty