Healthcare Provider Details

I. General information

NPI: 1053649632
Provider Name (Legal Business Name): HEALTH ACTIVATION SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 W BROADWAY AVE #200
ROBBINSDALE MN
55422-5604
US

IV. Provider business mailing address

4080 W BROADWAY AVE STE 200
ROBBINSDALE MN
55422-5604
US

V. Phone/Fax

Practice location:
  • Phone: 763-398-8888
  • Fax: 763-398-0670
Mailing address:
  • Phone: 763-398-8835
  • Fax: 763-398-0670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number1748
License Number StateMN

VIII. Authorized Official

Name: MS. JENNIFER DUNLEAVY
Title or Position: HR
Credential:
Phone: 763-398-8835