Individual
SUSAN W MACHARIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6808 158TH ST W, APPLE VALLEY, MN 55124-6027
(952) 992-0617
Mailing address
6808 158TH ST W, APPLE VALLEY, MN 55124-6027
(507) 401-6332
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
L792-152-834-118
MN
Other
Enumeration date
03/11/2024
Last updated
03/11/2024
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