Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 64033 | MN |
NPI | 1043208697 |
---|---|
Provider Name | Amanda M Termuhlen |
First Address | Minneapolis, MN 55455-0341 |
Second Address | Minneapolis, MN 55454-1450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 03/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0107712000 | MEDICAID (01) | WV |
0804928 | (05) | OH |
64869704 | MEDICAID (01) | KY |
F21815 | (02) |