Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant | MN |
NPI | 1124183470 |
---|---|
Provider Name | Loreen Kay Dragstra |
First Address | Edgerton, MN 56128-3613 |
Second Address | Marshall, MN 56258-1934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |