Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 7521 | MN |
NPI | 1184244139 |
---|---|
Provider Name | Ahnalieza Marie Brill |
First Address | Minneapolis, MN 55401-4437 |
Second Address | Minneapolis, MN 55454-1450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2020 |
Last Update Date | 07/07/2020 |