Provider Demographics
NPI:1396361879
Name:MALZ, STARANNE ANGELENNE
Entity Type:Individual
Prefix:
First Name:STARANNE
Middle Name:ANGELENNE
Last Name:MALZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MN
Mailing Address - Zip Code:56091
Mailing Address - Country:US
Mailing Address - Phone:507-521-0912
Mailing Address - Fax:
Practice Address - Street 1:1470 INDUSTRIAL DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-0700
Practice Address - Country:US
Practice Address - Phone:507-322-7751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other