Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1225210867 |
---|---|
Provider Name | Mrs. Cassandra K Amundson |
First Address | Saint Cloud, MN 56301-3401 |
Second Address | Saint Cloud, MN 56301-3401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2007 |
Last Update Date | 05/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
291NOLA | BCBS (01) | MN |