Provider Demographics
NPI:1235857673
Name:MARTHA'S OPEN HANDS PLLC
Entity Type:Organization
Organization Name:MARTHA'S OPEN HANDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRINCESS
Authorized Official - Middle Name:
Authorized Official - Last Name:GEHYIGON-WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:763-913-8125
Mailing Address - Street 1:7362 UNIVERSITY AVE NE STE 310-3
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:612-682-1206
Practice Address - Street 1:7362 UNIVERSITY AVE NE STE 310-3
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3142
Practice Address - Country:US
Practice Address - Phone:612-567-9587
Practice Address - Fax:612-682-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center