Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | R-073751-9 | MN |
NPI | 1154383016 |
---|---|
Provider Name | Sandra Greenquist |
First Address | Minneapolis, MN 55440-0043 |
Second Address | Saint Paul, MN 55102-2344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R70888 | (02) |