Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | R110940-5 | MN |
NPI | 1003900424 |
---|---|
Provider Name | Lois A Kubitschek |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Saint Paul, MN 55102-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 11/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
667516600 | (05) | MN |
S86710 | (02) | MN |