Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 5517-12 | WI |
NPI | 1285268342 |
---|---|
Provider Name | Steven Kreul |
First Address | Rochester, MN 55901-0229 |
Second Address | Rochester, MN 55901-0229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2020 |
Last Update Date | 16/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1396027629 | (05) | WI |