Provider Demographics
NPI:1952295552
Name:HOPE MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:HOPE MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WANYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:763-377-2069
Mailing Address - Street 1:5712 BROOKDALE DR N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3106
Mailing Address - Country:US
Mailing Address - Phone:763-377-2069
Mailing Address - Fax:
Practice Address - Street 1:5712 BROOKDALE DR N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3106
Practice Address - Country:US
Practice Address - Phone:763-377-2069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPE HEALTH INITIATIVE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty