Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 63819 | MN |
N | 111NI0900X | Internist | 63819 | MN |
N | 207R00000X | Internist | 65575 | WI |
N | 111NI0900X | Internist | 65575 | WI |
N | 207RC0000X | Internist - Cardiovascular Disease | 63819 | MN |
Y | 207RI0011X | Interventional Cardiology | 63819 | MN |
NPI | 1013336643 |
---|---|
Provider Name | John Nan |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 22/06/2021 |