Individual
DOMINIQUE THAXTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
540 FAIRVIEW AVE N, SAINT PAUL, MN 55104-1753
(952) 688-7308
Mailing address
6113 W BROADWAY AVE APT 326, NEW HOPE, MN 55428-3111
(952) 688-9754
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
08/19/2024
Last updated
08/19/2024
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