Individual
OWEN PAYNE KUSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16717 49TH PL N, PLYMOUTH, MN 55446
(763) 592-9613
Mailing address
16717 49TH PL N, PLYMOUTH, MN 55446
(763) 592-9613
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
MN
Other
Enumeration date
10/17/2016
Last updated
10/17/2016
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