Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 01030450A | IN |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 65016 | MN |
NPI | 1366562662 |
---|---|
Provider Name | Dr. Rowena Louise Archibald |
First Address | Bloomington, MN 55425-4516 |
Second Address | St Louis Park, MN 55416-2527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 12/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F94810 | (02) | NM |