Individual
TEQUILA BUCKHANON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5701 SHINGLE CREEK PKWY STE 250H, BROOKLYN CENTER, MN 55430-2344
(612) 695-5614
Mailing address
5701 SHINGLE CREEK PKWY STE 250H, BROOKLYN CENTER, MN 55430-2344
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
10827598
MN
343900000X
Non-emergency Medical Transport (VAN)
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Other
Enumeration date
07/02/2020
Last updated
07/02/2020
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