Individual
MS. KATHLEEN ANN IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDH
Contact information
Practice address
1670 BEAM AVE, MAPLEWOOD, MN 55109-1201
(651) 925-8400
(651) 925-8439
Mailing address
1670 BEAM AVE, MAPLEWOOD, MN 55109-1201
(651) 925-8400
(651) 925-8439
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H3571
MN
Other
Enumeration date
04/20/2011
Last updated
04/20/2011
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