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Organization
PROVAX LLC
Active
Organization
PROVAX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CINDY L EGELSTON R.N. (OWNER)
(952) 470-6005
Entity
Organization
Contact information
Practice address
2018 STONE CREEK DR, CHANHASSEN, MN 55317-7410
(952) 470-6005
Mailing address
2018 STONE CREEK DR, CHANHASSEN, MN 55317-7410
(952) 470-6005
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
R106374-5
MN
Other
Enumeration date
10/05/2009
Last updated
10/05/2009
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