Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 5880 | MN |
Y | 103TC0700X | Clinical Psychologist | 5880 | MN |
N | 103G00000X | Clinical Psychologist | 593 | AK |
N | 103TC0700X | Clinical Psychologist | 593 | AK |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 593 | AK |
N | 103G00000X | Clinical Psychologist | 593 | AK |
N | 103TC0700X | Clinical Psychologist | 593 | AK |
N | 103TF0200X | Forensic Psychologist | 593 | AK |
N | 103TM1800X | Intellectual & Developmental Disabilities | 593 | AK |
NPI | 1629150479 |
---|---|
Provider Name | Dr. Nan C Truitt |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Saint Paul, MN 55130-2400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 04/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1029222 | (05) | AK |