Healthcare Provider Details

I. General information

NPI: 1720982457
Provider Name (Legal Business Name): JENNIFER ANN HEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18582 ALABASTER RD
PINE CITY MN
55063-4882
US

IV. Provider business mailing address

18582 ALABASTER RD
PINE CITY MN
55063-4882
US

V. Phone/Fax

Practice location:
  • Phone: 320-245-5355
  • Fax: 320-216-7638
Mailing address:
  • Phone: 320-245-5355
  • Fax: 320-216-7638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberQ657115099518
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: