Individual
PEUANG BACCAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7515 11TH AVE S, RICHFIELD, MN 55423-4504
(612) 861-2337
Mailing address
7515 11TH AVE S, RICHFIELD, MN 55423-4504
(612) 861-2337
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
MN
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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