Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 5669 | MN |
NPI | 1073013181 |
---|---|
Provider Name | Stephanie Lynn Piche |
First Address | Andover, MN 55304-7608 |
Second Address | Andover, MN 55304-7608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2018 |
Last Update Date | 02/01/2020 |