Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 42369 | MN |
N | 207PP0204X | Pediatric Emergency Physician | 42369 | MN |
Y | 208000000X | Pediatrician | 42369 | MN |
N | 2080P0204X | Pediatric Emergency Doctor | 42369 | MN |
NPI | 1487731527 |
---|---|
Provider Name | Dr. Marlieke Van Tyn |
First Address | Saint Paul, MN 55102-2331 |
Second Address | Saint Paul, MN 55102-2331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 06/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
086670900 | (05) | MN |
34134900 | (05) | WI |
H49320 | (02) |