Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 4395 | MN |
NPI | 1093993693 |
---|---|
Provider Name | Dr. Virginia Petry Dunivan |
First Address | Saint Paul, MN 55105-1953 |
Second Address | Saint Paul, MN 55105-1953 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2008 |
Last Update Date | 05/05/2015 |