Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 42382 | MN |
Y | 207PP0204X | Pediatric Emergency Physician | 42382 | MN |
N | 208000000X | Pediatrician | 42382 | MN |
N | 2080P0204X | Pediatric Emergency Doctor | 42382 | MN |
NPI | 1790862738 |
---|---|
Provider Name | Kerry B Ace |
First Address | Minneapolis, MN 55407-3723 |
Second Address | Saint Paul, MN 55102-2346 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
380457700 | (05) | MN |
H29154 | (02) |