Provider Demographics
NPI:1447748728
Name:LAMIN, MAMUSU
Entity Type:Individual
Prefix:
First Name:MAMUSU
Middle Name:
Last Name:LAMIN
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:INDEPENDENT LIFE STYLES, INC
Mailing Address - Street 2:215 N. BENTON DRIVE
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379
Mailing Address - Country:US
Mailing Address - Phone:320-529-9000
Mailing Address - Fax:320-529-0747
Practice Address - Street 1:INDEPENDENT LIFE STYLES, INC
Practice Address - Street 2:215 N. BENTON DRIVE
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379
Practice Address - Country:US
Practice Address - Phone:320-529-9000
Practice Address - Fax:320-529-0747
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker