Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080N0001X | Neonatal-Perinatal Doctor | L8964 | TX |
Y | 2080N0001X | Neonatal-Perinatal Doctor | MD47955 | TN |
NPI | 1073693412 |
---|---|
Provider Name | Ann Stark |
First Address | Nashville, TN 37232-0001 |
Second Address | Boston, MA 02215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 04/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
164973301 | (05) | TX |
E02012 | (02) |