Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 4301101328 | MI |
Y | 207SG0201X | Clinical Genetics (M.D.) | 63019 | MN |
N | 208000000X | Pediatrician | 4301101328 | MI |
NPI | 1104172584 |
---|---|
Provider Name | Noelle Andrea Ventura Fabie |
First Address | Edina, MN 55436-1611 |
Second Address | Minneapolis, MN 55404-4518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2012 |
Last Update Date | 16/04/2018 |