Provider Information for 1467021139
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HEIDI MARIE SKATTEBO
Sex: Female
NPI: 1467021139
Last Updated: 2021-06-17
Certification Date: 2021-06-17
Certification Date: 2021-06-17
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1467021139 | ||||||||
| Enumeration Date | 2021-06-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1900 SILVER LAKE RD NW STE 110 NEW BRIGHTON, MN 55112-1789 United States Phone: 651-628-9566 | Fax: | ||||||||
| Primary Practice Address | 1811 WEIR DR STE 270 WOODBURY, MN 55125-6741 United States Phone: 651-714-9646 | Fax: | ||||||||
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