Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 63763 | MN |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 63763 | MN |
NPI | 1184064040 |
---|---|
Provider Name | Dr. Cassandra Kay Kisby |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 15/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
63763 | LICENSE (01) | MN |