Provider Demographics
NPI:1710444930
Name:XIONG, HNIA
Entity Type:Individual
Prefix:MR
First Name:HNIA
Middle Name:
Last Name:XIONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 STILLWATER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3626
Mailing Address - Country:US
Mailing Address - Phone:651-795-1022
Mailing Address - Fax:
Practice Address - Street 1:1585 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-3626
Practice Address - Country:US
Practice Address - Phone:651-795-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174200000X
MN1096660-1-AFC374U00000X
MN1094859-1-HCBS374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No174200000XOther Service ProvidersMeals