MEDICARE: ANNE MARIE DEROSIER MUENCH

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1801537139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE MARIE DEROSIER MUENCH

Provider Business Mailing Address
First Line	:	1618 BEECH ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-4909
Country	:	US
Telephone Number	:	651-276-3152
Fax Number	:

Provider Business Practice Location Address
First Line	:	1449 CLEVELAND AVE N
Second Line	:
City	:	FALCON HEIGHTS
State	:	MN
Zip	:	55108-1413
Country	:	US
Telephone Number	:	888-364-5977
Fax Number	:

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

Provider Enumeration Date	:	04/01/2022
Last Update Date	:	04/01/2022

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