Healthcare Provider Details

I. General information

NPI: 1386843704
Provider Name (Legal Business Name): TRAVELING ANGEL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6632 STATE 26
LA CRESCENT MN
55947-0163
US

IV. Provider business mailing address

3136 FLORIDA AVENUE S
ST. LOUIS PARK MN
55426
US

V. Phone/Fax

Practice location:
  • Phone: 612-483-2349
  • Fax: 507-894-4570
Mailing address:
  • Phone: 612-483-2349
  • Fax: 507-894-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEANETTE MARTINA VOLK KROHN
Title or Position: OWNER HOME CARE NURSE
Credential: LICENSED PRACTICAL N
Phone: 612-483-2349