Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LP 0368 | MN |
Y | 103T00000X | Psychologist | LP 0368 | MN |
NPI | 1013027192 |
---|---|
Provider Name | Ms. Ruth Brooke Markowitz |
First Address | St Paul, MN 55102-2273 |
Second Address | St Paul, MN 55102-2273 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04525MA | BCBSM (01) | MN |