Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 11015 | ZZ |
NPI | 1164918009 |
---|---|
Provider Name | Anne Beaudin |
First Address | Minneapolis, MN 55414-3950 |
Second Address | Minneapolis, MN 55455-0357 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2018 |
Last Update Date | 03/07/2018 |