Provider Demographics
NPI:1215606124
Name:SHENGENA, ANGELA M (CNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:SHENGENA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:VAN BENTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34700 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4500
Mailing Address - Country:US
Mailing Address - Phone:262-646-4411
Mailing Address - Fax:262-646-1049
Practice Address - Street 1:6442 CITY WEST PKWY STE 200
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-2809
Practice Address - Country:US
Practice Address - Phone:763-318-2800
Practice Address - Fax:763-318-2801
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8505363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health