Individual
KIAH MACKENZIE WARYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2620 EAGAN WOODS DR, EAGAN, MN 55121-1138
(651) 968-5151
Mailing address
2620 EAGAN WOODS DR, EAGAN, MN 55121-1138
(651) 968-5151
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3242
MN
Other
Enumeration date
01/31/2022
Last updated
11/01/2022
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