Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | R1485679 | MN |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R1485679 | MN |
NPI | 1265497291 |
---|---|
Provider Name | Teresa R Brost-Jipp |
First Address | Robbinsdale, MN 55422-2926 |
Second Address | Robbinsdale, MN 55422-2926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 13/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
288668500 | (05) | MN |