Individual
OWEGIO WREH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1405 SILVER LAKE ROAD SUITE 15, NEW BRIGHTON, MN 55112
(651) 280-7224
(651) 305-5256
Mailing address
1405 SILVER LAKE RD NW STE 15, NEW BRIGHTON, MN 55112-2204
(651) 280-7224
(651) 305-5256
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
814889146
PCA
MN
Enumeration date
04/22/2020
Last updated
04/22/2020
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