Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | A14750 | MN |
NPI | 1740726561 |
---|---|
Provider Name | Kirsten May |
First Address | Bemidji, MN 56601-5113 |
Second Address | Bemidji, MN 56601-5113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2017 |
Last Update Date | 18/01/2017 |