Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 67034 | MN |
N | 111NI0900X | Internist | 67034 | MN |
Y | 207RI0200X | Infectious Disease | 67034 | MN |
NPI | 1033471743 |
---|---|
Provider Name | Christa A Eickhoff |
First Address | Fargo, ND 58103-4940 |
Second Address | Brainerd, MN 56401-4529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2012 |
Last Update Date | 19/07/2021 |