Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 20200 | MN |
NPI | 1720066608 |
---|---|
Provider Name | Richard K Waeschle |
First Address | Mankato, MN 56001-6460 |
Second Address | Mankato, MN 56001-4752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D33496 | (02) | MN |