Individual
MARY T SALLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
(612) 365-6777
Mailing address
420 DELAWARE ST SE, MMC 366 (PEDS BMT), MINNEAPOLIS, MN 55455-0341
(612) 365-6777
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R193258-8
MN
Other
Enumeration date
09/27/2013
Last updated
09/27/2013
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