Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | CNP5041 | MN |
NPI | 1013457381 |
---|---|
Provider Name | Lydia Nyakonu Sherman |
First Address | Minneapolis, MN 55454-1455 |
Second Address | Minneapolis, MN 55454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2017 |
Last Update Date | 14/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013457381 | (05) | MN |