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General NPI Number Information
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NPI Number | 1740927284
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Entity Type | Individual
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Provider Name | ONORINE AMI SOH NP
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Gender | Female
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Dates
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Enumeration Date | 05/17/2022
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 4763 SUNFLOWER DR
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City | WOODBURY
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State | MN
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Zip | 55129-1402
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Country | US
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Telephone | 952-486-0124
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Fax |
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Provider Business Mailing Address
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Address Line | 4763 SUNFLOWER DR
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City | WOODBURY
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State | MN
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Zip | 55129-1402
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Country | US
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Telephone | 952-486-0124
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 2021210065
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License Number State | MN
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