Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 632 | MN |
NPI | 1073945150 |
---|---|
Provider Name | Caroline Ryder |
First Address | Minneapolis, MN 55408-2086 |
Second Address | Minneapolis, MN 55454-1450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2013 |
Last Update Date | 04/09/2019 |