Individual
LAVERN THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DME PROVIDER
Contact information
Practice address
1530 QUEEN AVE N, MINNEAPOLIS, MN 55411
(612) 701-8544
Mailing address
1530 QUEEN AVE N, MINNEAPOLIS, MN 55411
(612) 701-8544
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
72734346
MN
Other
Enumeration date
06/04/2009
Last updated
06/04/2009
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