Individual
MADELINE NICOLE DETRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2621 GREENHAVEN RD, ANOKA, MN 55303-5566
(763) 421-5540
Mailing address
2621 GREENHAVEN RD, ANOKA, MN 55303-5566
(763) 421-5540
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
1346244274
MN
Other
Enumeration date
05/16/2026
Last updated
05/16/2026
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