Healthcare Provider Details

I. General information

NPI: 1598954687
Provider Name (Legal Business Name): DANIELLE GOLDEN, CRNA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 TALMAGE CIR STE 216
VADNAIS HEIGHTS MN
55110-7100
US

IV. Provider business mailing address

3640 TALMAGE CIR STE 216
VADNAIS HEIGHTS MN
55110-7100
US

V. Phone/Fax

Practice location:
  • Phone: 952-431-5330
  • Fax: 952-431-5334
Mailing address:
  • Phone: 952-431-5330
  • Fax: 952-431-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number30635
License Number StateMN

VIII. Authorized Official

Name: DANIELLE L. GOLDEN
Title or Position: CEO
Credential: CRNA-DNP
Phone: 952-431-5330