Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 48694 | MN |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 48694 | MN |
NPI | 1083620306 |
---|---|
Provider Name | Gretchen A Voge |
First Address | Maple Grove, MN 55369-4200 |
Second Address | Maple Grove, MN 55369-4648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 12/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
656187000 | (05) | MN |
I 56301 | (02) | MN |