Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R 117770-9 | MN |
NPI | 1033186143 |
---|---|
Provider Name | Ms. Roxanna Y. Plouff |
First Address | Brooklyn Park, MN 55443-3720 |
Second Address | Brooklyn Park, MN 55443-3720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 22/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
715721500 | (05) | MN |