Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 41678 | MN |
NPI | 1255325213 |
---|---|
Provider Name | Wendy Marion Nelms Mccabe |
First Address | Shoreview, MN 55126-8064 |
Second Address | Shoreview, MN 55126-8064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1201039 | MEDICA (01) | MN |
1201042 | MEDICA (01) | MN |
299L4MC | (05) | MN |
CP9091026080 | PREFERRED ONE (01) | MN |
H33935 | (02) |