1255647798 NPI number — MRS. ANGELA VANDERHEYDEN NURSE PRACTITIONER

Table of content: MRS. ANGELA VANDERHEYDEN NURSE PRACTITIONER (NPI 1255647798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255647798 NPI number — MRS. ANGELA VANDERHEYDEN NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDERHEYDEN
Provider First Name:
ANGELA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TORP
Provider Other First Name:
ANGELA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255647798
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2243 GETTYSBURG AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55426-2341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-719-2173
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3850 PARK NICOLLET BLVD
Provider Second Line Business Practice Location Address:
SENIOR SERVICES
Provider Business Practice Location Address City Name:
SAINT LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55416-2527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-993-5041
Provider Business Practice Location Address Fax Number:
952-993-6406
Provider Enumeration Date:
08/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  R1691997 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com