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Phouvieng Sivilay
NPI 1245012715 · on the registry since 2023 · sole proprietor
Practice
- Address
- 10452 Spyglass Dr
Eden Prairie, MN 55347 - Phone
- (612) 508-8743
- Organisation at this address
- Chimney Pines Llc
Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- 310400000X
310400000X
- Licence states on file
- MN
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2023-10-18
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