Provider Demographics
NPI:1528560380
Name:FIELDS, ANGELA RANEE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RANEE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 CENTRE POINTE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1271
Mailing Address - Country:US
Mailing Address - Phone:651-368-6065
Mailing Address - Fax:651-454-5000
Practice Address - Street 1:2060 CENTRE POINTE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55120-1271
Practice Address - Country:US
Practice Address - Phone:651-368-6065
Practice Address - Fax:651-454-5000
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA148673100OtherUNIQUE MINNESOTA PROVIDER IDENTIFIER