Gloria Jean Dalle Poulos, NBC-HWC, FMCHC, CHES

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

6401 University Ave NE
Fridley, MN 55432-4341

Phone

(507) 330-0468

NPI assigned

Feb 28, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Gloria Dalle Poulos Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1582848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1902430960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6405 FRANCE AVE S STE W440",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352190",
            "telephone_number": "952-345-4165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554324341",
            "telephone_number": "507-330-0468"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6405 France Ave S Ste W440",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554352190",
            "country_code": "US",
            "telephone_number": "952-345-4165",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 W 98th St",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "MN",
            "postal_code": "554204773",
            "country_code": "US",
            "telephone_number": "507-330-0468",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DALLE POULOS",
        "first_name": "GLORIA",
        "middle_name": "JEAN",
        "credential": "NBC-HWC, FMCHC, CHES",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-28",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GLORIA",
            "last_name": "DALLE POULOS",
            "prefix": "MS.",
            "credential": "NBC-HWC, FMCHC, CHES",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Community Health Worker in Fridley, MN
• Providers in Fridley, MN by specialty
• Community Health Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; 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.