Individual
INGRID LOUISA NISSWANDT-LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4621 E SUPERIOR ST, DULUTH, MN 55804-2338
(218) 786-3550
Mailing address
4621 E SUPERIOR ST, DULUTH, MN 55804-2338
(218) 786-3550
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32323
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
922593500
—
MN
Enumeration date
09/27/2006
Last updated
10/11/2012
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