Provider Demographics
NPI:1366288557
Name:SENAR, JOHN R (CHW, MA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:SENAR
Suffix:
Gender:M
Credentials:CHW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2121
Mailing Address - Country:US
Mailing Address - Phone:612-423-4808
Mailing Address - Fax:612-465-3032
Practice Address - Street 1:1710 DOUGLAS DR N STE 120
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4352
Practice Address - Country:US
Practice Address - Phone:763-807-5254
Practice Address - Fax:612-465-3032
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker