Doctor Name: | MAGN NYANG |
NPI Number: | 1437588670 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | CC00670 |
Business Practice Address: | 542 82nd Ave Ne Spring Lake Park, MN - 554321907 |
Business Phone Number: | 6126368926 |
Business Fax Number: | |
Mailing Address: | 542 82nd Ave Ne, SPRING LAKE PARK |
State: | MN |
Postal Code: | 554321907 |
Phone Number: | 6126368926 |
Fax Number: | |
NPI Enumeration Date: | 11/07/2013 |
NPI Last Update Date: | 11/08/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | CC00670 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |