Individual
RUNGRAVEE PATTANAOLARN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15465 91ST AVE N, MAPLE GROVE, MN 55369-8869
(612) 396-8954
Mailing address
15465 91ST AVE N, MAPLE GROVE, MN 55369-8869
(612) 396-8954
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2485716
MN
Other
Enumeration date
06/14/2022
Last updated
06/14/2022
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