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General NPI Number Information
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NPI Number | 1962859058
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Entity Type | Organization
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Legal Business Name | AVERA MARSHALL
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 197 N TYLER ST
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City | TYLER
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State | MN
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Zip | 56178-1160
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Country | US
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Telephone | 507-247-5591
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Fax |
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Provider Business Mailing Address
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Address Line | 197 N TYLER ST
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City | TYLER
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State | MN
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Zip | 56178-1160
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Country | US
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Telephone | 507-247-5591
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DEBBIE STREIER
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Credential |
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Telephone | 507-537-9160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | MN
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