Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 42849 | MN |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 42849 | MN |
NPI | 1467406843 |
---|---|
Provider Name | Julie S Cronk |
First Address | Saint Paul, MN 55107-1827 |
Second Address | Saint Paul, MN 55110-5131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 28/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
077077900 | (05) | MN |