Individual
GLORIA JEAN DALLE POULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NBC-HWC, FMCHC, CHES
Contact information
Practice address
6401 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4341
(507) 330-0468
Mailing address
6405 FRANCE AVE S STE W440, EDINA, MN 55435-2190
(952) 345-4165
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
02/28/2020
Last updated
01/04/2022
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