Provider Demographics
NPI:1255647798
Name:VANDERHEYDEN, ANGELA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:VANDERHEYDEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:TORP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2243 GETTYSBURG AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-2341
Mailing Address - Country:US
Mailing Address - Phone:612-719-2173
Mailing Address - Fax:
Practice Address - Street 1:3850 PARK NICOLLET BLVD
Practice Address - Street 2:SENIOR SERVICES
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2527
Practice Address - Country:US
Practice Address - Phone:952-993-5041
Practice Address - Fax:952-993-6406
Is Sole Proprietor?:No
Enumeration Date:2010-08-22
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1691997363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology