Individual
PHOUVIENG SIVILAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10452 SPYGLASS DR, EDEN PRAIRIE, MN 55347-4656
(612) 508-8743
Mailing address
10428 SHELTER GRV, EDEN PRAIRIE, MN 55347-4855
(612) 508-8743
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
39902
MN
Other
Enumeration date
10/18/2023
Last updated
10/18/2023
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