Organization
MINNTRAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY MARRIN (ADMINISTRATOR)
(651) 775-1315
Entity
Organization
Contact information
Practice address
1700 LIVINGSTON AVE, SUITE 100, WEST ST PAUL, MN 55118-5908
(651) 775-1315
(651) 644-1369
Mailing address
1700 LIVINGSTON AVE, SUITE 100, WEST ST PAUL, MN 55118-5908
(651) 775-1315
(651) 644-1369
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
STS375379
MN
Other
Enumeration date
11/24/2014
Last updated
11/24/2014
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