Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant |
NPI | 1659443679 |
---|---|
Provider Name | Mrs. Kim Renae Kuechenmeister |
First Address | Madision, MN 56256 |
Second Address | Madision, MN 56256 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 14/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114995 | UCARE MEDICAID (01) | MN |
166363100 | (05) | MN |
46044MA | BLUE PLUS MEDICAID (01) | MN |