Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R-62916-4 | MN |
NPI | 1003115379 |
---|---|
Provider Name | Dr. Patricia Ann Kappas-Larson |
First Address | Roseville, MN 55113-7127 |
Second Address | Roseville, MN 55113-7127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2011 |
Last Update Date | 25/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R-62916-4 | STATE BOARD OF NSG (01) | MN |