Provider Demographics
NPI:1851124655
Name:EJNIK, MITCHELL WILLIAM (PMHNP)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:WILLIAM
Last Name:EJNIK
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:MITCHELL
Other - Middle Name:WILLIAM
Other - Last Name:EJNIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:1526 30TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4140
Mailing Address - Country:US
Mailing Address - Phone:218-751-0887
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:320-894-0094
Practice Address - Fax:218-759-4807
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12006363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health