Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 3659 | MN |
NPI | 1619973385 |
---|---|
Provider Name | Dr. Shalymar C Troumbly |
First Address | Rochester, MN 55901-3240 |
Second Address | Rochester, MN 55901-3240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 17/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
281M0LI | BCBS CONTRACTING PROVIDER (01) | MN |
291M7NE | BCBS INDIVIDUAL PROVIDER (01) | MN |
456719600 | MN CARE (01) | MN |
U95355 | (02) | MN |