Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | CNP1397 | MN |
NPI | 1003298308 |
---|---|
Provider Name | Rachel Anderson |
First Address | St Louis Park, MN 55416-4728 |
Second Address | St Louis Park, MN 55416-4728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2015 |
Last Update Date | 17/03/2018 |