Individual
EILEEN CAROL MUMFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1012 DIFFLEY RD, EAGAN, MN 55123-1778
(612) 913-2714
Mailing address
18519 ORCHARD TRL, LAKEVILLE, MN 55044-6621
(612) 913-2714
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
00005509
MN
Other
Enumeration date
02/27/2023
Last updated
02/27/2023
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