Provider Demographics
NPI:1043182801
Name:TRINITY HEALTH COMMUNITY CLINIC
Entity type:Organization
Organization Name:TRINITY HEALTH COMMUNITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:ETYANE
Authorized Official - Middle Name:
Authorized Official - Last Name:AYANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-465-1959
Mailing Address - Street 1:1555 SOUTHCROSS DR W STE 208
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-6938
Mailing Address - Country:US
Mailing Address - Phone:952-465-1959
Mailing Address - Fax:952-236-0138
Practice Address - Street 1:1555 SOUTHCROSS DR W STE 208
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-6938
Practice Address - Country:US
Practice Address - Phone:952-465-1959
Practice Address - Fax:952-236-0138
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NON PROFIT TRINITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty