Individual
MRS. CHARITY JOY VAILLANCOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
7740 HADLEY AVE S, COTTAGE GROVE, MN 55016-2651
(612) 224-0528
Mailing address
7740 HADLEY AVE S, COTTAGE GROVE, MN 55016-2651
(612) 224-0528
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
2460565
MN
Other
Enumeration date
08/17/2021
Last updated
08/17/2021
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