Provider Demographics
NPI:1700875101
Name:MVNA
Entity Type:Organization
Organization Name:MVNA
Other - Org Name:MINNESOTA VISITING NURSE AGENCY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN LIEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-617-4671
Mailing Address - Street 1:2000 SUMMER STREET NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413
Mailing Address - Country:US
Mailing Address - Phone:612-617-4600
Mailing Address - Fax:612-617-4782
Practice Address - Street 1:2000 SUMMER STREET NE
Practice Address - Street 2:SUITE 100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413
Practice Address - Country:US
Practice Address - Phone:612-617-4600
Practice Address - Fax:612-617-4782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN324640251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN569253900Medicaid
MN247008Medicare Oscar/Certification