Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation |
NPI | 1811419120 |
---|---|
Provider Name | Tamara Roseanne Nascene |
First Address | Lauderdale, MN 55113-5134 |
Second Address | Saint Paul, MN 55130-2400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2017 |
Last Update Date | 17/03/2018 |