Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 31775 | MN |
NPI | 1639140007 |
---|---|
Provider Name | Nancy K Henry |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 12/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35200000 | (05) | WI |
370011276 | RAILROAD MEDICARE (01) | MN |
552026600 | (05) | MN |
E49059 | (02) | |
ENROLLED | (05) | IA |
ENROLLED | (05) | SD |