Individual
TINA MAI HOUA THAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2300 W RUSSET CT, APPLETON, WI 54914-6285
(715) 572-0765
Mailing address
2300 W RUSSET CT, APPLETON, WI 54914-6285
(715) 572-0765
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
01/19/2022
Last updated
01/19/2022
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