Provider Demographics
NPI:1598409963
Name:DAMLE, NAMRATA NITEEN
Entity Type:Individual
Prefix:
First Name:NAMRATA
Middle Name:NITEEN
Last Name:DAMLE
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 1:6600 EXCELSIOR BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4713
Mailing Address - Country:US
Mailing Address - Phone:952-993-7705
Mailing Address - Fax:
Practice Address - Street 1:6600 EXCELSIOR BLVD STE 160
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4713
Practice Address - Country:US
Practice Address - Phone:952-993-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program