Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 61156 | MN |
NPI | 1710229190 |
---|---|
Provider Name | Dr. Callie Rae Becker |
First Address | Minneapolis, MN 55404-4518 |
Second Address | Minneapolis, MN 55454-1450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2013 |
Last Update Date | 25/11/2019 |