Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 54310 | MN |
N | 207QS0010X | Family Doctor - Sports Medicine | 54310 | MN |
NPI | 1225354947 |
---|---|
Provider Name | Nathan George Butler Waibel |
First Address | Edina, MN 55435-5864 |
Second Address | Edina, MN 55435-5864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2010 |
Last Update Date | 20/09/2021 |