Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5386 | MN |
N | 363LA2200X | Nurse Practitioner - Adult Health | 5386 | MN |
N | 363LG0600X | Nurse Practitioner - Gerontology | 5386 | MN |
NPI | 1043729064 |
---|---|
Provider Name | Grace Marie Irish |
First Address | Eden Prairie, MN 55344-3008 |
Second Address | St Louis Park, MN 55416-2527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2017 |
Last Update Date | 14/11/2017 |