Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0210X | Pediatric Nephrologist | 242353 | NY |
Y | 2080P0210X | Pediatric Nephrologist | 44250 | MN |
NPI | 1013053982 |
---|---|
Provider Name | Dr. Michelle Nicole Rheault |
First Address | Minneapolis, MN 55414 |
Second Address | Minneapolis, MN 55454-1404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 20/02/2013 |