Healthcare Provider Details

I. General information

NPI: 1568390367
Provider Name (Legal Business Name): MU KER PHUR SOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7066 STILLWATER BLVD N
OAKDALE MN
55128-3937
US

IV. Provider business mailing address

1596 CHAMBER ST
SAINT PAUL MN
55106-1112
US

V. Phone/Fax

Practice location:
  • Phone: 612-300-5011
  • Fax: 651-251-5111
Mailing address:
  • Phone: 651-235-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32445
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: