Healthcare Provider Details

I. General information

NPI: 1689220733
Provider Name (Legal Business Name): MARIA ANGELA DORAN-THREAT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA ANGELA THREAT

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11850 BLACKFOOT ST NW STE 300
COON RAPIDS MN
55433-2772
US

IV. Provider business mailing address

137 S BROADWAY AVE STE 7
ALBERT LEA MN
56007-2545
US

V. Phone/Fax

Practice location:
  • Phone: 763-236-0808
  • Fax: 763-236-6065
Mailing address:
  • Phone: 507-358-3085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6613
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11040597
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: