Individual
ANGELA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 OSBORNE RD NE, SUITE 215, FRIDLEY, MN 55432-2765
(763) 236-2707
Mailing address
500 OSBORNE RD NE, SUITE 215, FRIDLEY, MN 55432-2765
(763) 236-2707
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1027
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134225535
—
MN
05
—
1285887653
—
MN
05
—
1366440257
—
MN
05
—
1396852091
—
MN
05
—
1598191389
—
MN
05
—
1619938396
—
MN
05
—
1942317888
—
MN
Enumeration date
02/07/2017
Last updated
02/07/2017
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