Individual
SUSAN KAY DEVRIES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
604 DOUGLAS AVE, HENNING, MN 56551-4108
(218) 579-0319
Mailing address
604 DOUGLAS AVE, HENNING, MN 56551
(218) 579-0319
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1063787-1-AFC
MN
Other
Enumeration date
08/14/2012
Last updated
08/14/2012
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