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General NPI Number Information
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NPI Number | 1104645308
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Entity Type | Organization
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Legal Business Name | PRINCESS MANES
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 4171 LYNDALE AVE N
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City | MINNEAPOLIS
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State | MN
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Zip | 55412-1737
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Country | US
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Telephone | 612-451-9721
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Fax |
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Provider Business Mailing Address
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Address Line | 3123 RUSSELL AVE N # 1
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City | MINNEAPOLIS
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State | MN
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Zip | 55411-1018
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Country | US
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Telephone | 612-743-2688
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LATISHA MILLER
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Credential |
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Telephone | 612-743-2688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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