Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | 48674 | MN |
N | 208000000X | Pediatrician | 48674 | MN |
Y | 2080P0216X | Pediatric Rheumatologist | 48674 | MN |
NPI | 1710068978 |
---|---|
Provider Name | Mona M Riskalla |
First Address | Minneapolis, MN 55454-1450 |
Second Address | Minneapolis, MN 55454-1450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 07/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
573606400 | (05) | MN |
H05946 | (02) |