Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 6743 | MN |
NPI | 1033712450 |
---|---|
Provider Name | Becky Jo Vonbank |
First Address | Belle Plaine, MN 56011-8200 |
Second Address | Minneapolis, MN 55404-4518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2020 |
Last Update Date | 04/12/2020 |