Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 58115 | MN |
N | 111NI0900X | Internist | 58115 | MN |
Y | 207RP1001X | Pulmonary Disease | 58115 | MN |
NPI | 1013354513 |
---|---|
Provider Name | Amanda J Calvin |
First Address | St Louis Park, MN 55426-5000 |
Second Address | St Louis Park, MN 55426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2013 |
Last Update Date | 24/07/2020 |