Phoenix
NPI #1972118438 in North Branch, Minnesota
Provider Information
- NPI Number
- 1972118438
- Entity Type
- Organization
- Organization Name
- Phoenix
- Primary Specialty
- Voluntary or Charitable
- Enumeration Date
- Sep 11, 2020
- Last Updated
- Sep 11, 2020
Practice Location
- Address
- 6697 ELM ST
- City
- North Branch
- State
- Minnesota
- ZIP Code
- 55056-7045
- Phone
- (651) 795-8759
Authorized Official
- Name
- JEREMY JAMES KORTUS
- Title
- CO-FOUNDER
- Phone
- (651) 795-8759
Specialties & Taxonomy Codes
| Specialty |
|---|
| Voluntary or Charitable |
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