Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2648 | MN |
N | 111NR0200X | Radiology | 2648 | MN |
N | 213ER0200X | Radiology | 2648 | MN |
NPI | 1548344971 |
---|---|
Provider Name | Renee Marie Devries |
First Address | Bloomington, MN 55431-1602 |
Second Address | Bloomington, MN 55431-1602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |