Individual
MRS. KHADIJAH DESIREE BRUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1011 MEADOWLANDS DR, WHITE BEAR LAKE, MN 55127-2339
(612) 315-1976
Mailing address
1008 LAWSON AVE E, SAINT PAUL, MN 55106-3328
(651) 508-3555
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
MN
Other
Enumeration date
12/10/2021
Last updated
12/12/2021
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