Individual
ERISA ALIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1400 MADISON AVE STE 400A, MANKATO, MN 56001-6805
(507) 389-8538
Mailing address
1400 MADISON AVE STE 400A, MANKATO, MN 56001-6805
(507) 389-8538
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
78089
MN
Other
Enumeration date
05/05/2018
Last updated
12/05/2024
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