Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 363LA2100X | Nurse Practitioner | Acute Care | CNP 4517 | MINNESOTA | No |
| 2 | 363LA2200X | Nurse Practitioner | Adult Health | CNP 4517 | MINNESOTA | No |
| 3 | 363LG0600X | Nurse Practitioner | Gerontology | CNP 4517 | MINNESOTA | No |
| 4 | 363L00000X | Nurse Practitioner | | 041461373 | ILLINOIS | Yes |