NPIMap

Organization Active NPI

Desmoines Valley BHS

  • Clinical Nurse Specialist
  • Jackson, MN
National Provider Identifier
1407065824
Registry record updated Jan 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Nurse SpecialistTaxonomy code 364S00000X
License
R0902409 Issued in MN
Legal business name
DESMOINES VALLEY BHS
Practice address
803 4TH St
Jackson, MN 56143-1056
Phone
(507) 841-0916
Fax
(507) 847-5664
NPI assigned
May 22, 2007
Last updated
Jan 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Anita Handevidt, CNSNPI 1891705968
Title
Owner
Phone
(507) 841-0916

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Nurse Specialist 364S00000X R0902409 MN Primary

Addresses

Primary practice location

803 4TH St
Jackson, MN 56143-1056

Mailing address

PO Box 155
Jackson, MN 56143-0155

Other identifiers 2

IdentifierTypeStateIssuer
45718OtherMNSOUIX VALLEY
374M1DEOtherMNBC/BS OF MINNESOTA

National Provider Directory

National Provider Directory

Locations

204 2nd St
Ste 2
Jackson, MN 56143
Phone (507) 841-0916

803 4th St
Jackson, MN 56143
Phone (507) 841-0916

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199232000000",
    "number": "1407065824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 155",
            "city": "JACKSON",
            "state": "MN",
            "postal_code": "561430155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 4TH ST",
            "city": "JACKSON",
            "state": "MN",
            "postal_code": "561431056",
            "telephone_number": "507-841-0916",
            "fax_number": "507-847-5664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESMOINES VALLEY BHS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2008-01-02",
        "status": "A",
        "authorized_official_last_name": "HANDEVIDT",
        "authorized_official_first_name": "ANITA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-841-0916",
        "authorized_official_credential": "CNS"
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "MN",
            "license": "R0902409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUIX VALLEY",
            "identifier": "45718",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF MINNESOTA",
            "identifier": "374M1DE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.