Primal Infusions and Wellness

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PRIMAL INFUSIONS AND WELLNESS

Practice address

10455 165TH Ave SE
Becker, MN 55308-4110

Phone

(641) 691-8874

NPI assigned

Dec 18, 2023

Last updated

Dec 18, 2023By 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

Makyla Ann Wendroth, RN, BSN

Title

Owner

Phone

(641) 691-8874

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1702857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702857600000",
    "number": "1992573042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10455 165TH AVE SE",
            "city": "BECKER",
            "state": "MN",
            "postal_code": "553084110",
            "telephone_number": "641-691-8874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10455 165TH AVE SE",
            "city": "BECKER",
            "state": "MN",
            "postal_code": "553084110",
            "telephone_number": "641-691-8874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMAL INFUSIONS AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-18",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A",
        "authorized_official_last_name": "WENDROTH",
        "authorized_official_first_name": "MAKYLA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "641-691-8874",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Becker, MN
• Providers in Becker, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; 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.