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Individual

MAI DER THAO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2349 AMBERWOOD DR, WOODBURY, MN 55125-3025
(651) 497-7914
Mailing address
2349 AMBERWOOD DR, WOODBURY, MN 55125-3025

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
850446
PERSONAL CARE ASSISTANCE
MN
Enumeration date
07/16/2020
Last updated
07/16/2020
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