Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R2204752 | MN |
N | 363LF0000X | Nurse Practitioner - Family Medicine | A108831 | IA |
NPI | 1003229204 |
---|---|
Provider Name | Naomi Noelle Bach |
First Address | Worthington, MN 56187-2202 |
Second Address | Worthington, MN 56187-2202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2014 |
Last Update Date | 22/12/2014 |