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Individual

MRS. BREANN MARIE FORLITI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
12170 ABERDEEN ST NE, BLAINE, MN 55449-4716
(763) 757-7000
(763) 757-3328
Mailing address
3125 KENWOOD ST S, CAMBRIDGE, MN 55008-2640
(763) 689-4397

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3121
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1265694715
MN
Enumeration date
06/26/2008
Last updated
09/27/2010
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