Provider Demographics
NPI:1699476879
Name:DADZIE, PORTIA
Entity type:Individual
Prefix:
First Name:PORTIA
Middle Name:
Last Name:DADZIE
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 1:2834 BOBCAT TRL NW
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-4500
Mailing Address - Country:US
Mailing Address - Phone:612-441-7553
Mailing Address - Fax:
Practice Address - Street 1:2834 BOBCAT TRL NW
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-4500
Practice Address - Country:US
Practice Address - Phone:612-441-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare