Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1033764675 |
---|---|
Provider Name | Alex Amanda Foley |
First Address | Menomonee Falls, WI 53051-8300 |
Second Address | Milwaukee, WI 53208-3182 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2019 |
Last Update Date | 08/08/2019 |