Individual
LYNN M TAIVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
347 NORTH SMITH AVENUE, CHILDRENS SPECIALTY CLINIC NICU FOLLOW UP CLINIC, ST PAUL, MN 55102
(651) 220-8063
Mailing address
2910 CENTRE POINT DRIVE, 35-121A, ROSEVILLE, MN 55113
(651) 855-2327
(651) 855-2310
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R1371262
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221927100
—
MN
Enumeration date
03/31/2006
Last updated
09/06/2012
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