Individual
RYAN SELBRADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
427 E BLUE EARTH AVE, FAIRMONT, MN 56031-3948
(507) 230-0554
Mailing address
427 E BLUE EARTH AVE, FAIRMONT, MN 56031-3948
(507) 230-0554
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Y025290968607
MN
347C00000X
Private Vehicle
Primary
Y025290968607
MN
Other
Enumeration date
03/25/2014
Last updated
03/25/2014
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