Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 54104 | MN |
N | 208000000X | Pediatrician | RT 1594 | NH |
Y | 2080P0203X | Pediatric Critical Care Doctor | 54104 | MN |
NPI | 1104990191 |
---|---|
Provider Name | Dr. Gwenyth Anne Fischer |
First Address | Minneapolis, MN 55414 |
Second Address | Minneapolis, MN 55455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 31/05/2018 |