Individual
ROBERTA VAN AMBER PRIGGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9555 UPLAND LN N, MAPLE GROVE, MN 55369-4485
(952) 831-8742
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
39190
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
795820000
—
MN
Enumeration date
07/09/2006
Last updated
03/11/2021
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