Marisa Faye Brouse, ATC
Specialist in Edina, MN. Individual provider (NPI-1).
NPI number1356600860
StatusActive
Last updated in NPPESMay 4, 2012
Details
- NPI
- 1356600860
- Entity type
- Individual (NPI-1)
- Name
- Marisa Faye Brouse
- Credential
- ATC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 4, 2012
- Last updated
- May 4, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | 2235 | MN | Yes |
Practice location
8100 W 78th StEdina, MN 55439-2516
Phone 952-946-9777
Mailing address
3055 Eagandale Pl Apt 228Eagan, MN 55121-1239
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