Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 36642 | MN |
NPI | 1144274176 |
---|---|
Provider Name | Jeanne D Mrozek |
First Address | Maple Grove, MN 55369 |
Second Address | Maple Grove, MN 55369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 17/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F62126 | (02) | MN |