Individual
MARIE AGATHA THOMALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1810 4TH AVE APT 5, BALDWIN, WI 54002-5141
(715) 684-4655
Mailing address
122 CANABURY CT, LITTLE CANADA, MN 55117-1502
(763) 238-1979
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L 70522-4
MN
Other
Enumeration date
05/12/2011
Last updated
05/12/2011
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