Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 38233 | MN |
NPI | 1003833815 |
---|---|
Provider Name | Shelley M Lennox |
First Address | Minneapolis, MN 55407-1139 |
Second Address | Minneapolis, MN 55407-1139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 10/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2900012805 | RAILROAD MEDICARE (01) | MN |
G95379 | (02) | MN |