Individual
JACQUELINE VLIETSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2265 COMO AVE, SAINT PAUL, MN 55108-1737
(651) 379-6100
Mailing address
2265 COMO AVE, SAINT PAUL, MN 55108-1737
(651) 379-6100
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
58551
MN
Other
Enumeration date
10/28/2015
Last updated
10/28/2015
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