Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | ||
Y | 176B00000X | Midwife |
NPI | 1104102276 |
---|---|
Provider Name | Rebecca Ross Elizabeth Polston |
First Address | Minneapolis, MN 55408-3201 |
Second Address | Minneapolis, MN 55408-3201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2011 |
Last Update Date | 02/11/2011 |