Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 5967 | MN |
NPI | 1013493345 |
---|---|
Provider Name | Amy Jo Schwab |
First Address | Bemidji, MN 56601-5114 |
Second Address | Duluth, MN 55802-1844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2018 |
Last Update Date | 30/09/2019 |