Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013688332 |
---|---|
Provider Name | Amelia Cordell-Jaquez |
First Address | Rochester, MN 55902-1002 |
Second Address | Rochester, MN 55902-1002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2021 |
Last Update Date | 27/09/2021 |