Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R074428-5 | MN |
NPI | 1033101134 |
---|---|
Provider Name | Darrell R Rask |
First Address | Roseville, MN 55113-1182 |
Second Address | Saint Paul, MN 55102-2387 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 23/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
933403300 | (05) | MN |
S46261 | (02) |