Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 47414-020 | WI |
Y | 207Q00000X | Family Doctor | 52533 | MN |
NPI | 1003832791 |
---|---|
Provider Name | Lisa Ann Seeber |
First Address | Duluth, MN 55805-1951 |
Second Address | Virginia, MN 55792 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 26/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34598100 | (05) | WI |
680296600 | (05) | MN |
H82460 | (02) |