Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R0938017 | MN |
NPI | 1013976554 |
---|---|
Provider Name | Nancy Entgelmeier |
First Address | Roseville, MN 55113 |
Second Address | St Paul, MN 55102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 30/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
400815400 | (05) | MN |
S48220 | (02) |