Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R 125335-1 | MN |
NPI | 1003012667 |
---|---|
Provider Name | Cherie S. Nienow |
First Address | Roseville, MN 55113-3905 |
Second Address | Roseville, MN 55113-3905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 20/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
488467000 | (05) | MN |