Individual
PATTARAPHONGPAN CHAIYAMART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1048 CENTRAL AVE W, SAINT PAUL, MN 55104-4728
(612) 239-8235
Mailing address
1048 CENTRAL AVE W, SAINT PAUL, MN 55104-4728
(612) 239-8235
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
2489704
MN
Other
Enumeration date
02/01/2024
Last updated
02/02/2024
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