Provider Demographics
NPI:1922431212
Name:DEMERE, AVAELL (MST)
Entity Type:Individual
Prefix:
First Name:AVAELL
Middle Name:
Last Name:DEMERE
Suffix:
Gender:F
Credentials:MST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 DAKOTA ST S
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-3427
Mailing Address - Country:US
Mailing Address - Phone:612-619-7556
Mailing Address - Fax:
Practice Address - Street 1:11300 MINNETONKA MILLS RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5100
Practice Address - Country:US
Practice Address - Phone:952-933-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor