Individual
ANTIONETTE RUBY COATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9912 FILLMORE ST NE, BLAINE, MN 55434-3533
(612) 296-1991
Mailing address
9912 FILLMORE ST NE, BLAINE, MN 55434-3533
(612) 296-1991
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
M10311302104
MN
172A00000X
Driver
M103113024104
MN
Other
Enumeration date
12/27/2023
Last updated
12/27/2023
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