| NPI | 1780610139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE LYNN POPHAM Credentialing Specialist 651-209-8071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 435) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 435) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2012-01-25 |