Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1629285937 |
---|---|
Provider Name | Angelina Jeanine Constable |
First Address | Elk River, MN 55330-1885 |
Second Address | Maple Grove, MN 55369-4478 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 17/07/2008 |