Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LP1811 | MN |
Y | 103T00000X | Psychologist | LP1811 | MN |
NPI | 1003943432 |
---|---|
Provider Name | Patricia Lynn Layton |
First Address | Minneapolis, MN 55416-4688 |
Second Address | Minneapolis, MN 55416-4688 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 30/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7C244LA | BLUE CROSS BLUE SHIELD (01) | MN |