Search › Minnesota › 320900000X
Malissa Costanzo, OWNER
NPI 1003394479 · on the registry since 2018 · sole proprietor
Practice
- Address
- 844 8th Ave Se
Forest Lake, MN 55025 - Phone
- (651) 272-5608
Registry record
- Primary taxonomy
- 320900000X
320900000X
- Also registered as
- 253J00000X
- Licence states on file
- MN
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2018-08-01
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Minnesota