Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | LP2139 | MN |
N | 103T00000X | Psychologist | LP2139 | MN |
NPI | 1013010008 |
---|---|
Provider Name | Dr. Virginia Anne Mcdermott |
First Address | Minneapolis, MN 55402-2606 |
Second Address | Minneapolis, MN 55402-2606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 08/07/2007 |