Healthcare Provider Details

I. General information

NPI: 1508005620
Provider Name (Legal Business Name): MISS IA ONG HEU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 EMPIRE DR SUITE 123
SAINT PAUL MN
55103-1856
US

IV. Provider business mailing address

1610 GRANADA AVE N @118
OAKDALE MN
55128-4232
US

V. Phone/Fax

Practice location:
  • Phone: 651-222-2787
  • Fax: 651-224-1057
Mailing address:
  • Phone: 651-222-2787
  • Fax: 651-224-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: