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NPI 1063289866 · on the registry since 2023

Practice

Address
12843 Chisholm St Ne
Blaine, MN 55449
Phone
(651) 246-3309

Registry record

Primary taxonomy
207ZP0105X
207ZP0105X
Licence states on file
MN
From the registry's licence fields, which are often incomplete.
Sex
Female
Record last updated
2023-12-11

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Minnesota