Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2681 | MN |
NPI | 1831275809 |
---|---|
Provider Name | Virgina Rae Shinabarger |
First Address | Maple Lake, MN 55358 |
Second Address | Maple Lake, MN 55358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |