Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 4772 | MN |
NPI | 1124226345 |
---|---|
Provider Name | Dr. Bethanie Jo Schatz |
First Address | Hastings, MN 55033-2482 |
Second Address | Hastings, MN 55033-2482 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 10/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
078H7SC | MNBLS (01) | MN |
35003598 | (02) | MN |