Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LP2448 | MN |
Y | 103T00000X | Psychologist | LP2448 | MN |
NPI | 1003807454 |
---|---|
Provider Name | Brian Baschnagel |
First Address | Lake Elmo, MN 55042-8628 |
Second Address | Lake Elmo, MN 55042-8628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
62-52628 | UBH/MEDICA ID (01) | MN |
HP17573 | HEALTH PARTNERS ID (01) | MN |