Basic Information
| Provider Information | |||||||||
| NPI: | 1841918596 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | BSN, CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 270 MAIN ST N STE 300 | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550826788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513421039 | ||||||||
| FaxNumber: | 6513421428 | ||||||||
| Practice Location | |||||||||
| Address1: | 270 MAIN ST N STE 300 | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550826788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513421039 | ||||||||
| FaxNumber: | 6513421428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2022 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 9419 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LP2300X | 9419 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LG0600X | 9419 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363L00000X | 9419 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.