Provider Demographics
NPI:1457672321
Name:DINGMANN, JOANN KELLY (CPHT)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:KELLY
Last Name:DINGMANN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:MARY
Other - Last Name:REVELS,GUDVANGEN,FISHER,KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 EDISON BLVD
Mailing Address - Street 2:
Mailing Address - City:SILVER BAY
Mailing Address - State:MN
Mailing Address - Zip Code:55614-1211
Mailing Address - Country:US
Mailing Address - Phone:218-226-3829
Mailing Address - Fax:
Practice Address - Street 1:99 EDISON BLVD
Practice Address - Street 2:
Practice Address - City:SILVER BAY
Practice Address - State:MN
Practice Address - Zip Code:55614-1211
Practice Address - Country:US
Practice Address - Phone:218-226-3829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN721584183700000X
MN5101-0701-0058-243183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician