Healthcare Provider Details

I. General information

NPI: 1033073804
Provider Name (Legal Business Name): NATHANIEL ALLEN ENGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 E 38TH ST
MINNEAPOLIS MN
55407-5217
US

IV. Provider business mailing address

730 E 38TH ST
MINNEAPOLIS MN
55407-5217
US

V. Phone/Fax

Practice location:
  • Phone: 952-449-1894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34617
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: