Individual
LACEY EVELIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 MINERAL POND CT, ANOKA, MN 55303-1049
(763) 301-0539
Mailing address
400 MINERAL POND CT, ANOKA, MN 55303-1049
(763) 301-0539
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
785477
MN
Other
Enumeration date
02/13/2019
Last updated
02/13/2019
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