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Individual

ELLEN DE VRIES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
14000 FAIRVIEW DR, BURNSVILLE, MN 55337-5713
(952) 993-8700
Mailing address
6465 WAYZATA BLVD, SUITE 315, ST LOUIS PARK, MN 55426-1728

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
31602
MN

Other

Enumeration date
12/05/2005
Last updated
10/21/2011
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