| NPI | 1629373246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KOULA VANG Office Manager 651-636-5560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MN 30851) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 13954) |
| Enumeration Date | 2011-01-12 |
| Last Update Date | 2011-02-03 |