Healthcare Provider Details

I. General information

NPI: 1740502210
Provider Name (Legal Business Name): DANIELA G DEAN RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELA M GARTH RN, CNP

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OAKDALE AVE N
ROBBINSDALE MN
55422-2926
US

IV. Provider business mailing address

3300 OAKDALE AVE N
ROBBINSDALE MN
55422-2926
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-4260
  • Fax: 763-581-4261
Mailing address:
  • Phone: 763-581-4260
  • Fax: 763-581-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR 161950-0
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR 161950-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: