Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 62188 | MN |
Y | 208200000X | Surgeon | 62188 | MN |
Y | 208600000X | Surgeon | 62188 | MN |
NPI | 1053798728 |
---|---|
Provider Name | Kendall Mceachron |
First Address | Bloomington, MN 55425-4516 |
Second Address | Saint Paul, MN 55101-2502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2015 |
Last Update Date | 20/02/2020 |