Fridley Target Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

935 Issued in MN

Legal business name

FRIDLEY TARGET CLINIC

Practice address

755 53Rd Ave NE
Fridley, MN 55421-1240

Phone

(763) 571-9361

NPI assigned

Oct 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Millicent Wanjohi, PA-C

Title

Physician Assistant

Phone

(763) 571-9361

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457437907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12375 OAK PARK BLVD NE",
            "address_2": "APT # 206",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554347302",
            "telephone_number": "763-862-9656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 53RD AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554211240",
            "telephone_number": "763-571-9361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRIDLEY TARGET CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WANJOHI",
        "authorized_official_first_name": "MILLICENT",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "763-571-9361",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MN",
            "license": "935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Franklin, DNP
• Bianca Franks
• Jeffrey M Freed, M.D.
• Lisa Claire Freitag, M.D.
• Fridley Public Schools
• Matthew John Fritscher, LPCC
• Kristen Marie Fritsinger, MSW, LICSW
• Fundamentals Autism Center LLC
• Nariah Furlow
• Johnathan R Furzland, NP-C

• Primary Care Clinic/Center in Fridley, MN
• Providers in Fridley, MN by specialty
• Primary Care Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.