Most Relevant Information
Provider Data
| NPI Number: | 1003554148 |
| Provider Name: | WIDLYNE DESIR |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/26/2022 |
| Last Updated: | 07/20/2024 |
Provider Practice Location
1121 JACKSON ST NE STE 100
MINNEAPOLIS
MN
554133051
Practice Location Phone/Fax
| Phone: | 6124055876 |
| Fax: |
Provider Mailing Location
PO BOX 6836
SAINT PAUL
MN
551060836
Provider Mailing Phone/Fax
| Phone: | 6124055876 |
| Fax: |