Individual
FANTASIA MORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3111 124TH AVE NW STE 150, COON RAPIDS, MN 55433-4581
(763) 272-5877
Mailing address
3111 124TH AVE NW STE 150, COON RAPIDS, MN 55433-4581
(763) 272-5877
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/21/2024
Last updated
03/21/2024
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