Individual
MRS. MATILDA KLA-DIIHBAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
14096 GADWALL LN, ROGERS, MN 55374-8769
(612) 708-0910
Mailing address
5775 WAYZATA BLVD, SUITE 700, ST LOUIS PARK, MN 55416-1222
(612) 708-0910
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L047935-6
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
348032
CLASS HOME HEALTH PROFESIONAL AGENCY
MN
Enumeration date
08/28/2010
Last updated
08/28/2010
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