Provider Demographics
NPI:1093983470
Name:THOPRAKARN, ANOUPHAB ANDY
Entity Type:Individual
Prefix:
First Name:ANOUPHAB
Middle Name:ANDY
Last Name:THOPRAKARN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 92ND CRES
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1642
Mailing Address - Country:US
Mailing Address - Phone:763-425-5694
Mailing Address - Fax:651-224-1057
Practice Address - Street 1:4700 92ND CRES
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1642
Practice Address - Country:US
Practice Address - Phone:763-425-5694
Practice Address - Fax:651-224-1057
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant