Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 8275 | MN |
N | 363LA2200X | Nurse Practitioner - Adult Health | 8275 | MN |
NPI | 1023685138 |
---|---|
Provider Name | Mrs. Michelle Rae Neuschwander |
First Address | Thief River Falls, MN 56701-2700 |
Second Address | Thief River Falls, MN 56701-2819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2021 |
Last Update Date | 02/08/2021 |