Individual
ABBEGAYLE KISROW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2840 123RD AVE NW, MINNEAPOLIS, MN 55433-1727
(612) 916-2627
Mailing address
2840 123RD AVE NW, MINNEAPOLIS, MN 55433-1727
(612) 916-2627
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/05/2017
Last updated
10/05/2017
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