Individual
BRYNNE RAINIER WILSON LATTERELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D., M.P.H.
Contact information
Practice address
9555 UPLAND LN N, MAPLE GROVE, MN 55369-4485
(952) 993-1440
Mailing address
9555 UPLAND LN N, MAPLE GROVE, MN 55369-4485
(952) 993-1440
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
67086
MN
390200000X
Student in an Organized Health Care Education/Training Program
RS2017-0338
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
Other
Enumeration date
04/02/2017
Last updated
09/03/2020
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