Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 8439 | MN |
NPI | 1053089250 |
---|---|
Provider Name | Dr. Rachel Ann Tank |
First Address | Woodbury, MN 55125-3046 |
Second Address | Rochester, MN 55902-3003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2021 |
Last Update Date | 26/10/2021 |