Mahube-Otwa Community Action Partnership

Primary specialty

Non-Surgical Family Planning Clinic/CenterTaxonomy code 261QF0050X

Legal business name

MAHUBE-OTWA COMMUNITY ACTION PARTNERSHIP

Doing business as

Mahube-Otwa CAP Family Health

Practice address

119 Graystone PLZ Ste 110
Detroit Lakes, MN 56501-3034

Phone

(218) 847-1385

Fax

(218) 847-1388

NPI assigned

Mar 14, 2012

Last updated

Jul 31, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Elizabeth Kuoppala

Title

Executive Director

Phone

(218) 847-1385

Specialties & licenses 1

Addresses

Other names 1

• Mahube-Otwa CAP Family Health Doing business as

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Elizabeth Charles, CNM

  • Family Nurse Practitioner
  • Appleton, MN
  • NPI 1083108815
  NPD (past)
• Jennifer K Lessman, PA-C

  • Medical Physician Assistant
  • Detroit Lakes, MN
  • NPI 1205875598
  NPD (past)
• Rebecca D Peterson, APRN, CNP

  • Family Nurse Practitioner
  • Detroit Lakes, MN
  • NPI 1225662695
  NPD (past)
• Cynthia Kay Rastedt, RN, BSN

  • Community Health Registered Nurse
  • Detroit Lakes, MN
  • NPI 1740627710
  NPD (past)
• Tracy Darlene Smart

  • Community Health Registered Nurse
  • Brainerd, MN
  • NPI 1649617762
  NPD (past)
• Paul E. Vangorp, M.D.

  • Family Medicine Physician
  • Long Prairie, MN
  • NPI 1639160898
  NPD (past)

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

{
    "created_epoch": "1331683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1588939276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 W RIVER RD",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565012722",
            "telephone_number": "218-847-1385",
            "fax_number": "218-847-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 GRAYSTONE PLZ STE 110",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013034",
            "telephone_number": "218-847-1385",
            "fax_number": "218-847-1388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50 Centracare Dr",
            "address_purpose": "LOCATION",
            "city": "Long Prairie",
            "state": "MN",
            "postal_code": "563472100",
            "country_code": "US",
            "telephone_number": "218-346-3612",
            "fax_number": "218-844-5834",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 1st Ave S Ste B",
            "address_purpose": "LOCATION",
            "city": "Perham",
            "state": "MN",
            "postal_code": "565731445",
            "country_code": "US",
            "telephone_number": "218-346-3612",
            "fax_number": "218-844-5834",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "245 Barclay Ave",
            "address_purpose": "LOCATION",
            "city": "Pine River",
            "state": "MN",
            "postal_code": "564745174",
            "country_code": "US",
            "telephone_number": "218-346-3612",
            "fax_number": "218-844-5834",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 E 4th St",
            "address_purpose": "LOCATION",
            "city": "Morris",
            "state": "MN",
            "postal_code": "562672132",
            "country_code": "US",
            "telephone_number": "218-346-3612",
            "fax_number": "218-844-5834",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4 Deerwood Ave NW",
            "address_purpose": "LOCATION",
            "city": "Wadena",
            "state": "MN",
            "postal_code": "564821253",
            "country_code": "US",
            "telephone_number": "218-346-3612",
            "fax_number": "218-844-5834",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "128 W Cavour Ave",
            "address_purpose": "LOCATION",
            "city": "Fergus Falls",
            "state": "MN",
            "postal_code": "565372102",
            "country_code": "US",
            "telephone_number": "218-346-3612",
            "fax_number": "218-844-5834",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10 E Highway 28",
            "address_purpose": "LOCATION",
            "city": "Morris",
            "state": "MN",
            "postal_code": "562671176",
            "country_code": "US",
            "telephone_number": "218-346-3612",
            "fax_number": "218-844-5834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAHUBE-OTWA COMMUNITY ACTION PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-14",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A",
        "authorized_official_last_name": "KUOPPALA",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "218-847-1385"
    },
    "taxonomies": [
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mahube-Otwa CAP Family Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Trey William Lyngaas
• Peggy J Maasjo, NP
• Darren Garold Mack, PHARM D
• Kelli Marie Mack, OTR
• Mahube-Otwa Community Action Partnership
• Vinh Mai
• Ryan Richard Manke, DDS
• Olivia I Mann, DPT
• Amy Marchus, PHARM D
• Melanie Markuson, APRN, CNP

• Non-Surgical Family Planning Clinic/Center in Detroit Lakes, MN
• Providers in Detroit Lakes, MN by specialty
• Non-Surgical Family Planning Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; 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.