Provider Demographics
NPI:1386843704
Name:TRAVELING ANGEL PC
Entity Type:Organization
Organization Name:TRAVELING ANGEL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER HOME CARE NURSE
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:MARTINA
Authorized Official - Last Name:VOLK KROHN
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED PRACTICAL N
Authorized Official - Phone:612-483-2349
Mailing Address - Street 1:3136 FLORIDA AVENUE S
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426
Mailing Address - Country:US
Mailing Address - Phone:612-483-2349
Mailing Address - Fax:507-894-4570
Practice Address - Street 1:6632 STATE 26
Practice Address - Street 2:
Practice Address - City:LA CRESCENT
Practice Address - State:MN
Practice Address - Zip Code:55947-0163
Practice Address - Country:US
Practice Address - Phone:612-483-2349
Practice Address - Fax:507-894-4570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health