Provider Demographics
NPI:1346606530
Name:DAHLEN, ANDREW KEVIN (MA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:KEVIN
Last Name:DAHLEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 ULYSSES ST NE # 1
Mailing Address - Street 2:#1
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-3047
Mailing Address - Country:US
Mailing Address - Phone:651-214-3087
Mailing Address - Fax:
Practice Address - Street 1:16180 HASTINGS AVE SE
Practice Address - Street 2:SUITE 205
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-9227
Practice Address - Country:US
Practice Address - Phone:952-463-4600
Practice Address - Fax:952-463-4604
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program