Healthcare Provider Details

I. General information

NPI: 1376993816
Provider Name (Legal Business Name): PLOENA HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5923 SHETLAND DR NW
ROCHESTER MN
55901-3739
US

IV. Provider business mailing address

5923 SHETLAND DR NW
ROCHESTER MN
55901-3739
US

V. Phone/Fax

Practice location:
  • Phone: 612-321-8731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: