Khammany Phetsavong

NPI 1790097871 - Technician - 3747P1801X

NPI Details
NPI 1790097871
Gender Female
Enumeration Date 07/06/2010
Last Updated 07/06/2010
Entity Type Individual
Active Over 6 years ago
Practice Location
23 EMPIRE DR
SUITE 123
SAINT PAUL MN, 55103-1856, US
Phone (651) 222-2787
Fax (651) 224-1057
Business Location
1210 OMAHA AVE
WORTHINGTON MN, 56187-1844, US
Phone (651) 222-2787
Fax (651) 224-1057
Toxanomy
Taxonomy Code 3747P1801X
License State
License Number
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According to our database, Khammany Phetsavong NPI is 1790097871, taxonomy code is 3747P1801X Khammany Phetsavong physically located at 23 Empire Dr, Saint Paul MN, 55103-1856. NPI Number Khammany Phetsavong has the Individual type.

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1790097871 NPI number is provided on an as is basis without warranty of any kind. 1790097871 is maintained by the National Plan & Provider Enumeration System. The contents of Khammany Phetsavong are for informational purposes only.