Organization
DAVIS JACKSON MEDICAL ASSIST TEAN LEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FLORENSE MONIQUE DAVIS CNA (PRESIDENT/OWNER)
(651) 595-5960
Entity
Organization
Contact information
Practice address
6449 IPTH DR., SAINT PAUL, MN 55725-1130
(657) 592-5960
(651) 286-2994
Mailing address
1321 E. 78TH STREET APT. 114, BLOOMINGTON, MN 55425-1114
(651) 592-5960
(651) 286-2994
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
—
—
372600000X
Adult Companion
Primary
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
3747P1801X
Personal Care Attendant
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
11/06/2020
Last updated
11/06/2020
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