Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 9293 | MN |
NPI | 1134196348 |
---|---|
Provider Name | Sandra Baier Mccarthy |
First Address | Sauk Centre, MN 56378-1010 |
Second Address | Sauk Centre, MN 56378-1010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 04/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S52136 | (02) | AZ |