Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 1734 | MN |
NPI | 1750486262 |
---|---|
Provider Name | Russell Nieland |
First Address | Duluth, MN 55805-2433 |
Second Address | Duluth, MN 55805-2433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32B71NI | BCBSMN INDIVIDUAL (01) | MN |
40008000 | (05) | WI |
6411554 | MEDICA INDIVIDUAL (01) | MN |