Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | CNP 4378 | MN |
N | 363LG0600X | Nurse Practitioner - Gerontology | CNP 4378 | MN |
NPI | 1033576046 |
---|---|
Provider Name | Brooke Kern |
First Address | Roseville, MN 55113-4742 |
Second Address | Columbia Heights, MN 55421-2968 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2016 |
Last Update Date | 22/02/2016 |