Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 41406 | MN |
N | 207Q00000X | Family Doctor | 41406 | MN |
NPI | 1477645083 |
---|---|
Provider Name | Dr. Lisa Ellen Putney |
First Address | Bemidji, MN 56601-3921 |
Second Address | Bemidji, MN 56601-3122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G25954 | (02) | MN |