Individual
ANGENA PHOTHISANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1779 TYRONE DR, SHAKOPEE, MN 55379-3199
(612) 695-2488
Mailing address
1779 TYRONE DR, SHAKOPEE, MN 55379-3199
(612) 695-2488
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2496981
MN
Other
Enumeration date
02/11/2026
Last updated
02/11/2026
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