Healthcare Provider Details

I. General information

NPI: 1679989065
Provider Name (Legal Business Name): SEXABILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11670 FOUNTAINS DR 200
MAPLE GROVE MN
55369-7195
US

IV. Provider business mailing address

1121 W RIVER ST
MONTICELLO MN
55362-8952
US

V. Phone/Fax

Practice location:
  • Phone: 763-229-8508
  • Fax:
Mailing address:
  • Phone: 763-229-8508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberR11529-5
License Number StateMN

VIII. Authorized Official

Name: JANE ELIZABETH PARKER
Title or Position: OWNER
Credential: CNP
Phone: 763-229-8508