Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0127X | Trauma Surgeon | 7250 | MN |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 7250 | MN |
NPI | 1447883889 |
---|---|
Provider Name | Lorraine Woidylla |
First Address | Maple Grove, MN 55369-5408 |
Second Address | Robbinsdale, MN 55422-2926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2020 |
Last Update Date | 25/02/2020 |