Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 38591 | MN |
NPI | 1104886407 |
---|---|
Provider Name | Mary Zygmunt |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Fridley, MN 55432-2765 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 21/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
258319400 | (05) | MN |
B37888 | (02) |