Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 6605 | MN |
NPI | 1710523303 |
---|---|
Provider Name | Cody J Dessellier |
First Address | Monticello, MN 55362-4674 |
Second Address | Monticello, MN 55362-4674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2019 |
Last Update Date | 19/11/2019 |