Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R 161449-5 | MN |
NPI | 1003046996 |
---|---|
Provider Name | Michaela Anne Mclain |
First Address | Robbinsdale, MN 55422-2926 |
Second Address | Robbinsdale, MN 55422-2926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2009 |
Last Update Date | 07/07/2011 |