MEDICARE: SONG LOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1396954954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONG LOR

Provider Business Mailing Address
First Line	:	856 3RD ST E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-5141
Country	:	US
Telephone Number	:	651-776-6044
Fax Number	:

Provider Business Practice Location Address
First Line	:	856 3RD ST E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-5141
Country	:	US
Telephone Number	:	651-776-6044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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Directions to “ SONG LOR ” Practice Location

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