Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 32256259 | MN |
NPI | 1023306834 |
---|---|
Provider Name | Mrs. Rochelle D. Perry |
First Address | Mankato, MN 56001-5422 |
Second Address | Burnsville, MN 55337-4522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2011 |
Last Update Date | 28/07/2020 |