Provider Demographics
NPI:1316790884
Name:GARLEY-ALABI, AGNES D
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:D
Last Name:GARLEY-ALABI
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 1:8333 SHERIDAN AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-1521
Mailing Address - Country:US
Mailing Address - Phone:763-516-5717
Mailing Address - Fax:
Practice Address - Street 1:8333 SHERIDAN AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55444-1521
Practice Address - Country:US
Practice Address - Phone:763-516-5717
Practice Address - Fax:763-516-5717
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1718469163W00000X
MN11337363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse