Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301505034 | MI |
NPI | 1023498177 |
---|---|
Provider Name | Joshua Veenstra |
First Address | Bloomington, MN 55431-4800 |
Second Address | Bloomington, MN 55431-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 27/07/2021 |