Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 6361 | MN |
N | 2084N0400X | Neurologist | 6361 | MN |
NPI | 1003979881 |
---|---|
Provider Name | Elizabeth Rende |
First Address | Sauk Rapids, MN 56379-1065 |
Second Address | Saint Cloud, MN 56303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 13/05/2019 |