| NPI | 1790981157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI VANCE Director Of Administrative Services 651-303-5611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN MM1464522) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2020-08-22 |