Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 61426 | MN |
Y | 111NI0900X | Internist | 61426 | MN |
NPI | 1003236373 |
---|---|
Provider Name | Nicholas Charles Boysen |
First Address | Bloomington, MN 55425-4516 |
Second Address | Saint Paul, MN 55101-2502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2014 |
Last Update Date | 17/03/2018 |