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Organization
DAVIS JACKSON MEDICAL ASSIST TEAN LEE
Active
Organization
DAVIS JACKSON MEDICAL ASSIST TEAN LEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FLORENSE MONIQUE DAVIS CNA (PRESIDENT/OWNER)
(651) 595-5960
Entity
Organization
Contact information
Practice address
6449 IPTH DR., SAINT PAUL, MN 55725-1130
(657) 592-5960
(651) 286-2994
Mailing address
1321 E. 78TH STREET APT. 114, BLOOMINGTON, MN 55425-1114
(651) 592-5960
(651) 286-2994
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
—
—
372600000X
Adult Companion
Primary
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
3747P1801X
Personal Care Attendant
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
11/06/2020
Last updated
11/06/2020
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