Individual
MARK ALAN WAYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9175 62ND ST S, COTTAGE GROVE, MN 55016
(618) 980-6393
Mailing address
9175 62ND ST S, COTTAGE GROVE, MN 55016
(618) 980-6393
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
01/09/2024
Last updated
01/09/2024
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