Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25020 | MN |
N | 111NI0900X | Internist | 25020 | MN |
N | 207RN0300X | Nephrologist | 25020 | MN |
NPI | 1013974336 |
---|---|
Provider Name | William Robert Jahnke II |
First Address | St Paul, MN 55117-2074 |
Second Address | St Paul, MN 55102-2594 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B58277 | (02) |