Provider Demographics
NPI:1760071302
Name:IVORA HEALTH MINNESOTA LLC
Entity Type:Organization
Organization Name:IVORA HEALTH MINNESOTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAYLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:612-910-1070
Mailing Address - Street 1:703 WILLOUGHBY WAY W
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5344
Mailing Address - Country:US
Mailing Address - Phone:954-702-3372
Mailing Address - Fax:
Practice Address - Street 1:703 WILLOUGHBY WAY W
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55305-5344
Practice Address - Country:US
Practice Address - Phone:954-702-3372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty