Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5004181 | NC |
NPI | 1003059478 |
---|---|
Provider Name | Mavis Osei Yeboah |
First Address | Minnetonka, MN 55343-9664 |
Second Address | Minnetonka, MN 55343-9664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2009 |
Last Update Date | 29/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003059478 | (05) | NC |