Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 33821 | MN |
NPI | 1245269612 |
---|---|
Provider Name | Nicholas J Schneeman |
First Address | St Louis Park, MN 55416-1670 |
Second Address | Robbinsdale, MN 55422-2948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 24/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
575302300 | (05) | MN |
E58230 | (02) | MN |