Organization
CADAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY PERRON (AT CONSULTANT)
(952) 278-0559
Entity
Organization
Contact information
Practice address
4131 OLD SIBLEY MEMORIAL HWY, SUITE 200, EAGAN, MN 55122-1947
(651) 456-5760
Mailing address
4131 OLD SIBLEY MEMORIAL HWY, SUITE 200, EAGAN, MN 55122-1947
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
2144362
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
332BC3200X
—
MN
Enumeration date
01/07/2014
Last updated
01/07/2014
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