Individual
MEGAN PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
17680 FORMOSA AVE, FARMINGTON, MN 55024
(612) 616-4754
Mailing address
17680 FORMOSA AVE, FARMINGTON, MN 55024-7808
(612) 616-4754
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
244352-6
MN
Other
Enumeration date
02/23/2018
Last updated
09/07/2018
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