Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5402 | MN |
NPI | 1003334319 |
---|---|
Provider Name | Hannah L. Balfanz |
First Address | Minneapolis, MN 55418-2205 |
Second Address | Minneapolis, MN 55415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2017 |
Last Update Date | 07/09/2017 |