Individual
KYLIE MACZIEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
104 W 95TH ST, MINNEAPOLIS, MN 55420-4307
(952) 607-6749
Mailing address
104 W 95TH ST, BLOOMINGTON, MN 55420-4307
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/22/2020
Last updated
05/22/2020
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