Individual
LUCIA RODERIQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-3282
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
539
MN
367A00000X
Advanced Practice Midwife
Primary
539
MN
Other
Enumeration date
09/21/2022
Last updated
09/09/2024
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