Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | CNP3524 | MN |
NPI | 1003206731 |
---|---|
Provider Name | Camille Ashley Schwarzrock |
First Address | Bloomington, MN 55425-4516 |
Second Address | St Louis Park, MN 55426-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2015 |
Last Update Date | 06/04/2021 |