MEDICARE: MIREILLE KWADZO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker	405592	MN

General Provider Information

NPI Number	:	1235887407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIREILLE KWADZO

Provider Business Mailing Address
First Line	:	157 CHAPARRAL DR
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55124-9774
Country	:	US
Telephone Number	:	612-226-2147
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 CHAPARRAL DR
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55124-9774
Country	:	US
Telephone Number	:	612-226-2147
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2022
Last Update Date	:	09/13/2023

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Directions to “ MIREILLE KWADZO ” Practice Location

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