Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | CNP1167 | MN |
N | 363LP0200X | Nurse Practitioner - Pediatrics | R113223-6 | MN |
N | 363LP0200X | Nurse Practitioner - Pediatrics | R21613 | ND |
NPI | 1013995257 |
---|---|
Provider Name | Karen K Opp |
First Address | Duluth, MN 55805-1951 |
Second Address | Baxter, MN 56425-8331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 08/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
149815100 | (05) | MN |
R04739 | (02) | MN |