Provider Demographics
NPI:1689220733
Name:DORAN-THREAT, MARIA ANGELA (NP-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELA
Last Name:DORAN-THREAT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ANGELA
Other - Last Name:THREAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:45327 110TH ST
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013-7609
Mailing Address - Country:US
Mailing Address - Phone:507-358-3085
Mailing Address - Fax:
Practice Address - Street 1:800 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4575
Practice Address - Country:US
Practice Address - Phone:507-238-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily