Organization
Minnesota Vitality and Anti-Aging Center
Provider's NPPES record last updated: June 24, 2025
Overview
- Entity Type
- Organization
- NPI
- 1598330219
- Primary Specialty
- Clinic/Center
- Practice Location
- Shoreview, Minnesota
- Organization Subpart
- No
Federal Screening
NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.
List of Excluded Individuals/Entities (LEIE)
HHS Office of Inspector General
No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.
- Source data
- September 10, 2026
- Records indexed
- 84,001
- Screened
- Sep 19, 2026, 2:38 AM UTC
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
SAM.gov Exclusions
U.S. General Services Administration
SAM.gov Exclusions was not checked.
SAM.gov screening is not configured on this deployment. No SAM check has been performed.
- Screened
- Not checked
This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
Searches OIG LEIE and SAM.gov by name and reviews every potential match.
Specialties & Taxonomies
- Primary
Clinic/Center
Ambulatory Health Care Facilities
A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
Taxonomy code 261Q00000X Nurse Practitioner
Family
Physician Assistants & Advanced Practice Nursing Providers
Definition to come...
Taxonomy code 363LF0000XNurse Practitioner
Women's Health
Physician Assistants & Advanced Practice Nursing Providers
Definition to come...
Taxonomy code 363LW0102X
Practice Locations
Practice Location
520 Highway 96 W Ste 200
Shoreview, Minnesota 55126-1963
Phone: (651) 374-4014
Additional Practice Location
25 Lake St N Ste 120
Forest Lake, Minnesota 55025-2536
Phone: (651) 374-4014
Fax: (651) 374-4019
Record Information
- Enumeration Date
- May 25, 2021
- Provider's NPPES Record Last Updated
- June 24, 2025
- Certification Date
- June 24, 2025
- NPISignal NPPES Dataset
- August 2026
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