Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2012-10-03
- Last updated
- 2012-10-03
Specialties
Licenses
- License MN
- 358062
Location
- Practice location
- 2528 PARK AVE NW
- City
- BEMIDJI MN
- Postal code
- 566012432
- Phone
- 218-333-3854
Organization contact
- Name
- SHELLEY CLOOSE
- Title
- President
- Phone
- 2183333854
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.