Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 62827 | MN |
NPI | 1003270232 |
---|---|
Provider Name | Andrea Langeveld |
First Address | Bloomington, MN 55425-4516 |
Second Address | Saint Paul, MN 55130-5302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2016 |
Last Update Date | 08/07/2020 |