Provider Demographics
NPI:1780391995
Name:RADANT, JENA J
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:J
Last Name:RADANT
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 1:1265 GREY FOX RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6938
Mailing Address - Country:US
Mailing Address - Phone:651-917-4622
Mailing Address - Fax:
Practice Address - Street 1:1779 GREYSTONE RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-2743
Practice Address - Country:US
Practice Address - Phone:612-384-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator