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Specialty details in registry · Saint Paul, MN

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At a glance

331 Maple Street, Saint Paul, MN 55106

NPPES record updated Jan 12, 2017. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

331 Maple Street Suite 2
Saint Paul, MN 55106
Professional details: NPI, taxonomy & registry record
NPI1063958247
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Registry details

Primary taxonomy
Specialty details in registry
Taxonomy code
305R00000X
Enumeration date
Jan 12, 2017
Record updated
Jan 12, 2017
More registry details
Provider type
Organization · Type 2
Other reported name
<UNAVAIL>

Reported taxonomies and licenses

Specialty details in registry

305R00000X · Primary

License reported: 377579 MN

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

331 Maple Street
Suite 2
Saint Paul, MN 55106
Phone
(612) 251-4577
Mailing address
331 MAPLE ST
SUITE 2
SAINT PAUL, MN 551065132
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

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