Healthcare Provider Details

I. General information

NPI: 1215800552
Provider Name (Legal Business Name): ALICE MARIE VOLTAIRE VALENTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W SAINT GERMAIN ST STE 1
SAINT CLOUD MN
56301-3665
US

IV. Provider business mailing address

PO BOX 17370 LOT 6675
SAINT PAUL MN
55117
US

V. Phone/Fax

Practice location:
  • Phone: 320-237-8155
  • Fax:
Mailing address:
  • Phone: 320-237-8155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: