Provider Demographics
NPI:1821775222
Name:POLLEY, ANGELA (MA, NBC-HWC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:POLLEY
Suffix:
Gender:F
Credentials:MA, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23876 186TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-7700
Mailing Address - Country:US
Mailing Address - Phone:952-212-6951
Mailing Address - Fax:
Practice Address - Street 1:23876 186TH ST NW
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-7700
Practice Address - Country:US
Practice Address - Phone:952-212-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA-3675915171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach