Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 6920 | MN |
NPI | 1073163515 |
---|---|
Provider Name | Dr. Alissa Pool |
First Address | Minneapolis, MN 55414-2924 |
Second Address | Minneapolis, MN 55454-1450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2019 |
Last Update Date | 04/10/2019 |