Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | CNP4569 | MN |
NPI | 1023375227 |
---|---|
Provider Name | Mr. Saul Sandford Kissin |
First Address | Rochester, MN 55904-6756 |
Second Address | Rochester, MN 55904-6756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2012 |
Last Update Date | 14/09/2016 |