Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | CNP 4854 | MN |
NPI | 1003368929 |
---|---|
Provider Name | Divina Fama Bikeri |
First Address | Minneapolis, MN 55425-4516 |
Second Address | Andover, MN 55304-3538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2016 |
Last Update Date | 10/05/2017 |