Angella Marie Tharaldson

Primary specialty

PharmacistTaxonomy code 183500000X

License

120089 Issued in MN

Practice address

10 W Lake St
Minneapolis, MN 55408-3116

Phone

(612) 827-5309

NPI assigned

Feb 27, 2013

Last updated

Feb 27, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Angella Marie Hegdahl Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361923200000",
    "number": "1902146046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5551 SHOREVIEW AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554171919",
            "telephone_number": "218-626-7223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 W LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554083116",
            "telephone_number": "612-827-5309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THARALDSON",
        "first_name": "ANGELLA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-27",
        "last_updated": "2013-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "120089",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "16158-040",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELLA",
            "last_name": "HEGDAHL",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Diana Tharalson, LICSW
• Matthew Allen Thate, OT
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• The Aliveness Project, Inc. (THRIVERx)

• Pharmacist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.