Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 599 | MN |
Y | 222Z00000X | Podiatrist | 599 | MN |
NPI | 1073545851 |
---|---|
Provider Name | Maren Elze |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Maplewood, MN 55109-1162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 01/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
752823000 | (05) | MN |
U68379 | (02) |