Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R127314-0 | MN |
NPI | 1013010172 |
---|---|
Provider Name | Marjorie G Webb |
First Address | Wilson, WI 54027 |
Second Address | Saint Paul, MN 55102-2534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P36887 | (02) | MN |