Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | LP1446 | MN |
NPI | 1043330426 |
---|---|
Provider Name | Kristin Muyskens |
First Address | Saint Paul, MN 55104-4804 |
Second Address | Saint Paul, MN 55104-4804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
432MOMU | BCBS (01) | MN |
6251781 | MEDICA (01) | MN |
HP21885 | HP (01) | MN |