Individual
MS. KATIE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
2501 LAKEWOOD LN, MOUND, MN 55364-1608
(952) 472-7814
Mailing address
2501 LAKEWOOD LN, MOUND, MN 55364-1608
(952) 472-7814
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
715458
MN
Other
Enumeration date
02/05/2015
Last updated
02/05/2015
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