Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 29124 | MN |
Y | 2086S0129X | Vascular Surgeon | 65817 | MN |
NPI | 1093210262 |
---|---|
Provider Name | Dr. Nolan C Cirillo-Penn |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2018 |
Last Update Date | 27/08/2020 |