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Individual

MIRANDA MARIE LACROIX

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-STUDENT

Contact information

Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-3456
Mailing address
640 JACKSON ST, SAINT PAUL, MN 55101-2595
(651) 254-3456

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13913
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
378862
WISCONSIN NURSE AIDE
WI
Enumeration date
09/15/2020
Last updated
12/06/2021
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