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Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Pediatrics

Provider NPI: 1215230354

Provider Information:
Gender: F
Sole Proprietor

Practice Location:
Tel: 651-336-4773  Fax: --

Business Mailing Address:
Tel: 952-239-8591  Fax: --

NPI Information:
NPI: 1215230354
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y363LP0200XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
N363LP0222XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 363LP0200X





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