IndividualActive
Grace Line
NPI 1790318186 · Driver · Andover, MN
Provider details
- NPI number
- 1790318186
- Entity type
- Individual
- Primary specialty
- DriverOther Service Providers
- Sex
- Female
- Sole proprietor
- No
- License
- B772-020-465-216 (MN)
Specialties & taxonomies
Other Service Providers
Practice location
2934 168th Ln Nw
Andover, MN 55304-1928
Phone: (218) 481-5357
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 15192
Duluth, MN 55815-0192
Additional practice locations (1)
- 6588 Fredenberg Lake RdDuluth, MN 55803-9468Phone: (218) 481-5357
Registry dates
- Enumerated
- 2020-02-13
- Last updated
- 2020-02-13
- Certified
- 2020-02-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.