Individual
WAYNE SENIOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CEO
Contact information
Practice address
13503 THRUSH ST NW, ANDOVER, MN 55304-3991
(763) 479-9153
Mailing address
13503 THRUSH ST NW, ANDOVER, MN 55304-3991
(763) 479-9153
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033395488
—
MN
Enumeration date
11/26/2020
Last updated
11/26/2020
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