Provider Demographics
NPI:1982065983
Name:DAGAN WELLNESS LLC
Entity type:Organization
Organization Name:DAGAN WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DENARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-210-7996
Mailing Address - Street 1:311 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3026
Mailing Address - Country:US
Mailing Address - Phone:952-210-7996
Mailing Address - Fax:
Practice Address - Street 1:311 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3026
Practice Address - Country:US
Practice Address - Phone:952-210-7996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care