Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 366 | MN |
NPI | 1083108815 |
---|---|
Provider Name | Elizabeth Charles |
First Address | Appleton, MN 56208-1616 |
Second Address | Appleton, MN 56208-1616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2018 |
Last Update Date | 08/03/2021 |