Individual
DESIREE DEANOVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
300 STATE AVE, FARIBAULT, MN 55021-6319
(507) 333-3300
Mailing address
2640 86TH CT W, NORTHFIELD, MN 55057-4234
(952) 456-2042
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
13767
MN
363A00000X
Physician Assistant
Primary
13767
MN
Other
Enumeration date
09/29/2021
Last updated
10/11/2021
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