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General NPI Number Information
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NPI Number | 1093942195
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Entity Type | Organization
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Legal Business Name | IN-HOME CLINIC CONNECTION PC
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 03/05/2010
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Provider Practice Location Address
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Address Line | 4570 W 77TH ST SUITE 165
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City | EDINA
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State | MN
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Zip | 55435-5008
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Country | US
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Telephone | 952-230-7633
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Fax | 952-842-9001
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Provider Business Mailing Address
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Address Line | 4570 W 77TH ST SUITE 165
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City | EDINA
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State | MN
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Zip | 55435-5008
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Country | US
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Telephone | 952-230-7633
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Fax | 952-842-9001
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Authorized Official
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Title or Position | CEO
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Name | MS. KATHLEEN JOY VALUSEK
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Credential | C-NP
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Telephone | 952-842-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | PENDING
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License Number State |
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