Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 2889-033 | WI |
NPI | 1033128657 |
---|---|
Provider Name | Alene Ruth Math |
First Address | Independence, WI 54747-8177 |
Second Address | Eau Claire, WI 54701-3410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 17/08/2007 |