Organization
DIVINE HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR T DAVIS (CO-OWNER)
(952) 288-9921
Entity
Organization
Contact information
Practice address
625 SNELLING AVE N STE A-2, SAINT PAUL, MN 55104-2878
(952) 288-9921
Mailing address
625 SNELLING AVE N STE A-2, SAINT PAUL, MN 55104-2878
(952) 288-9921
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/04/2022
Last updated
03/04/2022
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