Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 5210 | MN |
NPI | 1023538659 |
---|---|
Provider Name | Laurie Geddes |
First Address | Mendota Heights, MN 55120-1733 |
Second Address | Minneapolis, MN 55415-1623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2017 |
Last Update Date | 24/06/2017 |