Individual
MARISA FAYE BROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
8100 W 78TH ST, EDINA, MN 55439-2516
(952) 946-9777
Mailing address
3055 EAGANDALE PL APT 228, EAGAN, MN 55121-1239
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2235
MN
Other
Enumeration date
05/04/2012
Last updated
05/04/2012
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