Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 531 | ND |
NPI | 1194789891 |
---|---|
Provider Name | Mrs. Corrine Marie Vatnsdal-Geck |
First Address | Bismarck, ND 58503-8877 |
Second Address | Bismarck, ND 58501-4439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 11/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
54970 | (05) | ND |
VAT25158 | BLUE CROSS BLUE SHIELD (01) | ND |