Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251E1200X | Ergonomics | 100806 | MN |
Y | 225XE1200X | Ergonomics | 100806 | MN |
NPI | 1699739763 |
---|---|
Provider Name | Mrs. Jessica J Ogren |
First Address | Inver Grove Heights, MN 55077-5471 |
Second Address | Saint Paul, MN 55118-5105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100806 | STATE LICENSE NUMBER (01) | MN |