Healthcare Provider Details

I. General information

NPI: 1770184129
Provider Name (Legal Business Name): NURSES ON THE GO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6449 RATH DRIVE
SAINT PAUL MN
55125-1130
US

IV. Provider business mailing address

1321 EAST 78TH STREET SUITE 114
BLOOMINGTON MN
55425-1114
US

V. Phone/Fax

Practice location:
  • Phone: 651-443-6221
  • Fax: 651-286-2994
Mailing address:
  • Phone: 651-443-6221
  • Fax: 651-286-2994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANTONIETTE NICOLE JACKSON
Title or Position: PRESIDENT/OWNER
Credential: C.N.A.
Phone: 651-443-6221