Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 515 | MN |
Y | 222Z00000X | Podiatrist | 515 | MN |
NPI | 1043307739 |
---|---|
Provider Name | Mindy L Benton |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Saint Paul, MN 55108-5107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 11/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
533718600 | (05) | MN |