Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC3878 | MN |
NPI | 1447306105 |
---|---|
Provider Name | Dr. Tammy Tremmel Nyhus |
First Address | Prior Lake, MN 55372-1770 |
Second Address | Prior Lake, MN 55372-1770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U9438 | (02) | MN |