Individual
MS. BREANNA LEA BACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1962 CARDINAL DR, SHAKOPEE, MN 55379-4418
(612) 619-1567
Mailing address
1962 CARDINAL DR, SHAKOPEE, MN 55379-4418
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L 69958-9
MN
Other
Enumeration date
07/08/2011
Last updated
07/08/2011
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