Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 107975 5 | MN |
NPI | 1033149778 |
---|---|
Provider Name | Brenda Beck Reiter |
First Address | Minneapolis, MN 55404-3074 |
Second Address | Minneapolis, MN 55404-3074 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P50068 | (02) | TX |