Avaell Demere, MST
Individual provider Active NPI Contractor · Minnetonka, MN
NPI 1922431212 · NPPES record last updated Aug 9, 2013
Key facts
- NPI
- 1922431212
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 11300 Minnetonka Mills Rd
Minnetonka, MN 55305-5100 - Phone
- (952) 933-3000
- NPI assigned
- Aug 9, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
11300 Minnetonka Mills Rd
Minnetonka, MN 55305-5100
Mailing address
1116 Dakota St S
Shakopee, MN 55379-3427
Phone (612) 619-7556
Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.