Individual
BECKY JO IMGRUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
111 HUNDERTMARK RD, CHASKA, MN 55318-4551
(952) 442-2191
(952) 442-8055
Mailing address
13819 102ND PL N, MAPLE GROVE, MN 55369-7501
(303) 548-6564
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
106752
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54503744
—
CO
01
—
P00739790
RR MEDICARE
CO
Enumeration date
04/04/2007
Last updated
02/01/2023
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