Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 45476 | MN |
NPI | 1003815051 |
---|---|
Provider Name | Jennifer J Rogan |
First Address | St Cloud, MN 56303 |
Second Address | St Cloud, MN 56303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I01234 | (02) |