Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | R804 | MN |
NPI | 1033789821 |
---|---|
Provider Name | Elizabeth Burgstahler |
First Address | Minneapolis, MN 55455-0357 |
Second Address | Minneapolis, MN 55455-0357 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2021 |
Last Update Date | 25/06/2021 |