Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AG12170092 | MN |
NPI | 1073021184 |
---|---|
Provider Name | Kari Annette Baillif |
First Address | Little Falls, MN 56345-3558 |
Second Address | Little Falls, MN 56345-3558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2018 |
Last Update Date | 30/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AG12170092 | (05) | MN |