Individual
MADELEINE GRACE DERBIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16500 W 78TH ST # B, EDEN PRAIRIE, MN 55346-4302
(763) 614-7021
Mailing address
10753 23RD ST NE, SAINT MICHAEL, MN 55376-7502
(763) 614-7021
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
MN
Other
Enumeration date
09/13/2021
Last updated
07/06/2023
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