Provider Demographics
NPI:1659143204
Name:HOLSOMS TMS MENTAL WELLNESS CLINIC
Entity Type:Organization
Organization Name:HOLSOMS TMS MENTAL WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER - MENTAL H
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:N
Authorized Official - Last Name:OMARI
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:763-639-3356
Mailing Address - Street 1:13691 BALSAM LN N
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:55327-6900
Mailing Address - Country:US
Mailing Address - Phone:763-639-3356
Mailing Address - Fax:651-374-9641
Practice Address - Street 1:13691 BALSAM LN N
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:MN
Practice Address - Zip Code:55327-6900
Practice Address - Country:US
Practice Address - Phone:763-639-3356
Practice Address - Fax:651-374-9641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty