Individual
MR. JEROME TODD REZAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
216 E MAIN ST, SUITE 1, ALBERT LEA, MN 56007-2919
(507) 373-4300
(507) 373-4304
Mailing address
216 E MAIN ST, SUITE 1, ALBERT LEA, MN 56007-2919
(507) 373-4300
(507) 373-4304
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L 65492-2
MN
Other
Enumeration date
10/06/2010
Last updated
10/06/2010
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