Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | R 235077-4 | MN |
NPI | 1003265349 |
---|---|
Provider Name | Derek Przybylski |
First Address | Green Bay, WI 54304-3942 |
Second Address | Minneapolis, MN 55404-4518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2016 |
Last Update Date | 07/06/2016 |