Healthcare Provider Details

I. General information

NPI: 1629102520
Provider Name (Legal Business Name): ALETHEA J DRAHOS CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 S SERVICE DR
RED WING MN
55066-1882
US

IV. Provider business mailing address

605 HILLCREST AVE STE 130
OWATONNA MN
55060-3680
US

V. Phone/Fax

Practice location:
  • Phone: 651-388-1515
  • Fax: 651-388-5912
Mailing address:
  • Phone: 507-451-0290
  • Fax: 507-451-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberU.S. 97791
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: