Healthcare Provider Details

I. General information

NPI: 1730960246
Provider Name (Legal Business Name): VI SIIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6445 RICHFIELD PKWY
RICHFIELD MN
55423-6400
US

IV. Provider business mailing address

6445 RICHFIELD PKWY
RICHFIELD MN
55423-6400
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10556
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: