Individual
MARY ELLEN VENZKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19729 183RD AVENUE, BIG LAKE, MN 55309
(763) 263-1119
Mailing address
19729 183RD AVENUE, BIG LAKE, MN 55309
(763) 263-1119
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
1055394-1-AFC
MN
Other
Enumeration date
02/18/2010
Last updated
02/18/2010
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