Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 6768 | MN |
NPI | 1063067981 |
---|---|
Provider Name | Angela Nicole Score |
First Address | Golden Valley, MN 55422-4544 |
Second Address | Golden Valley, MN 55422-4544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2019 |
Last Update Date | 11/11/2019 |