| NPI | 1295715001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY DRAGER CFO 651-698-2406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: IA 33019) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2024-08-15 |