Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 50432 | MN |
Y | 2080P0214X | Pediatric Pulmonologist | 50432 | MN |
NPI | 1578756045 |
---|---|
Provider Name | Christina Lee Mikesell |
First Address | Minneapolis, MN 55404-4289 |
Second Address | Minneapolis, MN 55404-4289 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2007 |
Last Update Date | 19/10/2011 |