# PRINCESS MANES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013736214
- **Authorized official:** LA TISHA MILLER (OWNER)
- **Authorized official phone:** (612) 743-2688

## Contact information

- **Practice address:** 4171 LYNDALE AVE N, MINNEAPOLIS, MN 55412-1737
- **Practice address phone:** (612) 451-9721
- **Mailing address:** 3123 RUSSELL AVE N \# 1, MINNEAPOLIS, MN 55411-1018
- **Mailing address phone:** (612) 743-2688

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 10/07/2024
- **Last updated:** 10/07/2024