Individual
PHENG THAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1615 EUCLID ST, SAINT PAUL, MN 55106-5905
(651) 210-7681
Mailing address
1615 EUCLID ST, SAINT PAUL, MN 55106-5905
(651) 210-7681
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
2485063
MN
Other
Enumeration date
11/16/2020
Last updated
11/16/2020
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