Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 11039 | MN |
NPI | 1023508876 |
---|---|
Provider Name | Josie Anderson |
First Address | North Branch, MN 55056-5248 |
Second Address | Pine City, MN 55063-2000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2018 |
Last Update Date | 17/05/2018 |