Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 5780 | MN |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 5780 | MN |
NPI | 1083114300 |
---|---|
Provider Name | Dr. Sanouk Xiong |
First Address | Brooklyn Center, MN 55429-4008 |
Second Address | Brooklyn Center, MN 55429-4008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2018 |
Last Update Date | 17/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F01180845 | AMERICAN ACADEMY OF NURSE PRACTITONERS (01) | MN |