Individual
AMI KOMLANVI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
18580 JOPLIN AVE, LAKEVILLE, MN 55044-4218
(952) 892-9500
Mailing address
18580 JOPLIN AVE, LAKEVILLE, MN 55044-4218
(952) 892-9500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11347
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265874366
—
MN
Enumeration date
07/18/2013
Last updated
11/02/2022
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