Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D8197 | MN |
Y | 213EG0000X | General Practice | D8197 | MN |
NPI | 1003092206 |
---|---|
Provider Name | Anita Whalen |
First Address | Crookston, MN 56716-2799 |
Second Address | Warren, MN 56762-0093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2008 |
Last Update Date | 19/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
531018100 | (05) | MN |