Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 102684 | MN |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 49260 | MN |
NPI | 1003910563 |
---|---|
Provider Name | Lisa-Ann Wuermser |
First Address | Minneapolis, MN 55422-4249 |
Second Address | Minneapolis, MN 55422-4249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 14/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
375412000 | (05) | MN |
G51113 | (02) |