Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 5126 | MN |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 5126 | MN |
NPI | 1043743784 |
---|---|
Provider Name | Rhonda Young |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Minneapolis, MN 55407-1321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2017 |
Last Update Date | 07/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
245098-8 | REGISTERED NURSE LICENSE NUMBER (01) | MN |
5126 | APRN LICENSE (01) | MN |
YOU1-0440-5702 | NATIONAL CERTIFICATION CORPORATION (01) |