Healthcare Provider Details

I. General information

NPI: 1679188627
Provider Name (Legal Business Name): VISANA HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 HENNEPIN AVE APT 3
MINNEAPOLIS MN
55408-3855
US

IV. Provider business mailing address

3524 HENNEPIN AVE APT 3
MINNEAPOLIS MN
55408-3855
US

V. Phone/Fax

Practice location:
  • Phone: 402-659-4020
  • Fax:
Mailing address:
  • Phone: 402-659-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH MICHAEL CONNOLLY
Title or Position: CEO
Credential:
Phone: 402-659-4020