Provider Demographics
NPI:1275172462
Name:INTENTIONAL WELLNESS SOLUTIONS
Entity Type:Organization
Organization Name:INTENTIONAL WELLNESS SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C, PMHNP-BC
Authorized Official - Phone:612-232-2917
Mailing Address - Street 1:30 1ST AVE NE STE 7
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1515
Mailing Address - Country:US
Mailing Address - Phone:763-400-8177
Mailing Address - Fax:304-301-3047
Practice Address - Street 1:30 1ST AVE NE STE 7
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1515
Practice Address - Country:US
Practice Address - Phone:763-400-8177
Practice Address - Fax:304-301-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center