Provider Demographics
NPI:1518406024
Name:ADAN, DEQA (CHW)
Entity Type:Individual
Prefix:
First Name:DEQA
Middle Name:
Last Name:ADAN
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 20TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1329
Mailing Address - Country:US
Mailing Address - Phone:612-636-9728
Mailing Address - Fax:
Practice Address - Street 1:311 UNIVERSITY AVE NE
Practice Address - Street 2:101
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1379
Practice Address - Country:US
Practice Address - Phone:612-430-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker