Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H4583 | MN |
NPI | 1063039642 |
---|---|
Provider Name | Barbara Lynn Naastad |
First Address | Cass Lake, MN 56633-3360 |
Second Address | Cass Lake, MN 56633-3360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2020 |
Last Update Date | 02/07/2020 |