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NPI 1063289866 · Clinical Pathology/Laboratory Medicine Physician · Blaine, MN
Provider details
- NPI number
- 1063289866
- Entity type
- Individual
- Primary specialty
- Clinical Pathology/Laboratory Medicine PhysicianAllopathic & Osteopathic Physicians
- Sex
- Female
- Sole proprietor
- No
- License
- 274197 (MN)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
12843 Chisholm St Ne
Blaine, MN 55449-4873
Phone: (651) 246-3309
Approximate (ZIP-level) locationGet directions
Mailing address
12843 Chisholm St Ne
Blaine, MN 55449-4873
Registry dates
- Enumerated
- 2023-12-11
- Last updated
- 2023-12-11
- Certified
- 2023-12-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.