Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 37163 | MN |
Y | 207PP0204X | Pediatric Emergency Physician | 37163 | MN |
N | 208000000X | Pediatrician | 37163 | MN |
N | 2080P0204X | Pediatric Emergency Doctor | 37163 | MN |
NPI | 1790897460 |
---|---|
Provider Name | Karen L Hick |
First Address | Roseville, MN 55113 |
Second Address | Minneapolis, MN 55404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 01/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
615514500 | (05) | MN |
G43268 | (02) |