Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 65328 | MN |
NPI | 1033537782 |
---|---|
Provider Name | Erin Sellinger |
First Address | Plymouth, MN 55447-4485 |
Second Address | Plymouth, MN 55447-4485 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 19/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
65328 | LICENSE (01) | MN |