Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 4916 | MN |
NPI | 1710020698 |
---|---|
Provider Name | Dr. Michelle Eddy |
First Address | Monticello, MN 55362-1576 |
Second Address | Monticello, MN 55362-9322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 31/08/2015 |