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Individual

MARY S MICHENER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
859 MANKATO AVENUE, WINONA CLINIC LTD, WINONA, MN 55987
(507) 454-3680
(507) 457-7672
Mailing address
859 MANKATO AVENUE, WINONA CLINIC LTD, WINONA, MN 55987
(507) 454-3680
(507) 457-7672

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38452
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
636227300
MN
Enumeration date
08/08/2006
Last updated
12/13/2011
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