Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | MD.38724 | AL |
NPI | 1134519093 |
---|---|
Provider Name | Asri Yuliati |
First Address | Mobile, AL 36640-0480 |
Second Address | Mobile, AL 36604-1541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2015 |
Last Update Date | 29/06/2020 |