Healthcare Provider Details

I. General information

NPI: 1831709468
Provider Name (Legal Business Name): REBECCA ANITA TVETEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10505 WAYZATA BLVD STE 203-3
MINNETONKA MN
55305-1502
US

IV. Provider business mailing address

10505 WAYZATA BLVD STE 203-3
MINNETONKA MN
55305-1502
US

V. Phone/Fax

Practice location:
  • Phone: 651-252-8001
  • Fax: 866-318-3073
Mailing address:
  • Phone: 651-252-8001
  • Fax: 866-318-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: