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Individual

DOVILE NAZAREVYCH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2205 W MEDICINE LAKE DR, PLYMOUTH, MN 55441-4142
(612) 707-1660
Mailing address
2205 W MEDICINE LAKE DR, PLYMOUTH, MN 55441-4142
(612) 707-1660

Taxonomy

Speciality
Code
Description
License number
State
247ZC0005X
Clinical Laboratory Director (Non-physician)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
24D2245122
CMS, CLIA NUMBER
MN
Enumeration date
01/21/2022
Last updated
01/21/2022
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