Provider Demographics
NPI:1619490893
Name:MEWINZHA ONDAADIZIIKE WIIGAMING
Entity Type:Organization
Organization Name:MEWINZHA ONDAADIZIIKE WIIGAMING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILLICENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:218-556-1961
Mailing Address - Street 1:802 PAUL BUNYAN DR S STE 12
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3204
Mailing Address - Country:US
Mailing Address - Phone:218-444-4323
Mailing Address - Fax:218-444-7514
Practice Address - Street 1:802 PAUL BUNYAN DR S STE 12&13
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3201
Practice Address - Country:US
Practice Address - Phone:218-444-4323
Practice Address - Fax:218-444-7514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN163W00000X, 163WC0400X, 163WC1500X, 164W00000X, 374J00000X
MNR-158189-02083P0901X, 363LC1500X, 363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty