Individual
KAYLA RUBAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1126 WESTRAC DR S, FARGO, ND 58103-2473
(701) 412-2973
Mailing address
891 BELSLY BLVD, MOORHEAD, MN 56560-5055
(218) 287-4338
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BMS00002
—
Other
Enumeration date
08/09/2019
Last updated
10/03/2019
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