Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 43205 | MN |
NPI | 1124042510 |
---|---|
Provider Name | Dr. Lucinda Mary Marty |
First Address | Saint Cloud, MN 56303-2015 |
Second Address | Saint Cloud, MN 56303-2015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |