Individual
BRIAN HOLM IMDIEKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-4401
Mailing address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R 157007-6
MN
Other
Enumeration date
03/19/2013
Last updated
03/19/2013
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