Healthcare Provider Details

I. General information

NPI: 1528998648
Provider Name (Legal Business Name): CHLOE TANALEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 JAY LN
WHITE BEAR LAKE MN
55110-4446
US

IV. Provider business mailing address

4015 JAY LN
WHITE BEAR LAKE MN
55110-4446
US

V. Phone/Fax

Practice location:
  • Phone: 651-460-0171
  • Fax: 651-460-0171
Mailing address:
  • Phone: 651-460-0171
  • Fax: 651-460-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: