Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 43877 | MN |
NPI | 1265529663 |
---|---|
Provider Name | Lissa N Chipeco |
First Address | Minneapolis, MN 55425-4516 |
Second Address | Saint Paul, MN 55108-1460 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 11/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
028720200 | (05) | MN |
H48464 | (02) |