Healthcare Provider Details

I. General information

NPI: 1669428470
Provider Name (Legal Business Name): CHARITY LEE ANGLE RN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CHICAGO AV S SUITE 300
MINNEAPOLIS MN
55407-1320
US

IV. Provider business mailing address

2800 CHICAGO AV S SUITE 300
MINNEAPOLIS MN
55407-1320
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-5390
  • Fax: 612-863-2697
Mailing address:
  • Phone: 612-863-5390
  • Fax: 612-863-2697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberR0939197
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: