Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 63050-20 | WI |
N | 207VG0400X | Gynecologist | 036127848 | IL |
NPI | 1073889382 |
---|---|
Provider Name | Anastasia Osipova |
First Address | Lake Geneva, WI 53147-2655 |
Second Address | Lake Geneva, WI 53147-2655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2012 |
Last Update Date | 09/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073889382 | (05) | WI |
1073889382 | BCBSWI (01) | WI |