Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 31726 | MN |
Y | 208600000X | Surgeon | 31726 | MN |
NPI | 1003487406 |
---|---|
Provider Name | Irina Kanzafarova |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2021 |
Last Update Date | 07/07/2021 |