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General NPI Number Information
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NPI Number | 1942018122
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Entity Type | Individual
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Provider Name | SEIPATI VALERIE KGOMO
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 364 SUNSET AVE 306
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City | LAKE PARK
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State | MN
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Zip | 60506
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Country | US
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Telephone | 218-234-5238
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Fax |
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Provider Business Mailing Address
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Address Line | 178 MEADOW LN APT 203
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City | DETROIT LAKES
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State | MN
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Zip | 56501-2455
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Country | US
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Telephone | 218-234-5238
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 3747P1801X
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License Number State | MN
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