Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 7081 | MN |
NPI | 1013547850 |
---|---|
Provider Name | Lexie Frances Polk |
First Address | Wayzata, MN 55391-9360 |
Second Address | Saint Paul, MN 55118-5114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2020 |
Last Update Date | 09/06/2021 |