Individual
HEAVENLY LACE MABE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
921 2ND AVE S, FARGO, ND 58103-1705
(701) 318-8204
Mailing address
921 2ND AVE S, FARGO, ND 58103-1705
(701) 318-8204
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
448
ND
Other
Enumeration date
01/17/2024
Last updated
10/11/2024
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