Healthcare Provider Details

I. General information

NPI: 1396579900
Provider Name (Legal Business Name): ANGELINA DAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17685 JUNIPER PATH
LAKEVILLE MN
55044-9819
US

IV. Provider business mailing address

6068 158TH CT W
APPLE VALLEY MN
55124-6206
US

V. Phone/Fax

Practice location:
  • Phone: 952-214-8959
  • Fax:
Mailing address:
  • Phone: 952-212-7735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: