Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 01078832A | IN |
Y | 207K00000X | Allergist & Immunologist | TP071 | KY |
NPI | 1164782751 |
---|---|
Provider Name | Amy W Castilano |
First Address | Louisville, KY 40223-2992 |
Second Address | Florence, KY 41042-4852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2012 |
Last Update Date | 26/05/2021 |