Individual
ANTENALU DESTA TONA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8340 5TH ST NE, SPRING LAKE PARK, MN 55432-1135
(612) 886-5439
Mailing address
8340 5TH ST NE, SPRING LAKE PARK, MN 55432-1135
(612) 886-5439
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10993
MN
Other
Enumeration date
11/23/2023
Last updated
11/23/2023
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