Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D11153 | MN |
Y | 213EG0000X | General Practice | D11153 | MN |
NPI | 1003934324 |
---|---|
Provider Name | Dr. Julie Ann Nyland |
First Address | Sartell, MN 56377-2153 |
Second Address | Sartell, MN 56377-2153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 11/12/2007 |