Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 62645 | MN |
NPI | 1336594498 |
---|---|
Provider Name | Jaimi Lynn Weber |
First Address | Golden Valley, MN 55422-4841 |
Second Address | Fridley, MN 55432-1876 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2016 |
Last Update Date | 03/08/2021 |