Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 54701 | MN |
N | 208D00000X | General Practice Physician | 11013785A | IN |
NPI | 1033317730 |
---|---|
Provider Name | Megan Susan Johnston Flanders |
First Address | Cannon Falls, MN 55009-1824 |
Second Address | Cannon Falls, MN 55009-1824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 28/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033317730 | (05) | MN |