Healthcare Provider Details

I. General information

NPI: 1891813184
Provider Name (Legal Business Name): DEL CARMEN MARKETING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 MAIN ST S
SAUK CENTRE MN
56378-1646
US

IV. Provider business mailing address

857 MAIN ST S
SAUK CENTRE MN
56378-1646
US

V. Phone/Fax

Practice location:
  • Phone: 320-352-5227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number2621
License Number StateMN

VIII. Authorized Official

Name: DR. LOVETTE MIECZKOWSKI
Title or Position: OWNER
Credential: D.C.
Phone: 320-352-5227