NPI | 1629373246 |
---|---|
Entity Type | Organization |
Authorized Contact | KOULA VANG Office Manager 651-636-5560 |
Organization Subpart ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: MN 30851) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 13954) |
Enumeration Date | 2011-01-12 |
Last Update Date | 2011-02-03 |