Lao Pha is a Driver based in Big Lake, MN. Lao Pha practices in Big Lake, MN. The NPI Number for Lao Pha is 1245639301 and holds a License No. 374889 (Minnesota).
The current practice location address for Lao Pha is 171 Lake St N # 102, Big Lake, MN and can be reached out via phone at 651-774-1166.
Location: 171 Lake St N # 102, Big Lake, MN, 55309-9254
Provider Profile Details
NPI Number
1245639301
Provider Name
Lao Pha
Credential
Provider Entity Type
Individual
Gender
Male
Address
171 Lake St N # 102, Big Lake, MN, 55309-9254
Phone Number
651-774-1166
Fax Number
Provider Enumeration Date
08/14/2014
Last Update Date
03/09/2024
Provider's Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A304195200 | 05 | MN |
Provider Business Practice Location Address Details
Address
171 Lake St N # 102
City
State
Zip
55309-9254
Phone Number
651-774-1166
Fax Number
Provider Business Mailing Address Details
Address
171 Lake St N # 102
City
State
Zip
55309-9254
Phone Number
651-774-1166
Fax Number
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Driver
Speciality
-
Taxonomy
License No.
374889 (Minnesota)
Definition
A person employed to operate a motor vehicle as a carrier of persons or property.
Badge
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