Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 5647 | ND |
NPI | 1003833773 |
---|---|
Provider Name | Lidia D Krasniewska |
First Address | Fargo, ND 58103-3602 |
Second Address | Fargo, ND 58103-3602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D28630 | (02) |