Provider Demographics
NPI:1952134785
Name:EJNIK AND ASSOCIATES LLC
Entity type:Organization
Organization Name:EJNIK AND ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:EJNIK
Authorized Official - Suffix:
Authorized Official - Credentials:CNP, PMHNP
Authorized Official - Phone:320-894-0094
Mailing Address - Street 1:23713 STATE 200
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:MN
Mailing Address - Zip Code:56461-4104
Mailing Address - Country:US
Mailing Address - Phone:320-894-0094
Mailing Address - Fax:218-759-4807
Practice Address - Street 1:1526 30TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4140
Practice Address - Country:US
Practice Address - Phone:218-751-0887
Practice Address - Fax:218-759-4807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty