Individual
LYNNE M DIDRIKSON I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
20 5TH ST SE, COOK, MN 55723-9702
(218) 666-5941
Mailing address
20 5TH ST SE, COOK, MN 55723
(218) 666-5941
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27836
MN
Other
Enumeration date
09/27/2006
Last updated
07/28/2009
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