Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 8068A | WY |
NPI | 1033100953 |
---|---|
Provider Name | Bernadette Veronica Meade |
First Address | Gillette, WY 82717-3046 |
Second Address | Gillette, WY 82716-3246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 05/01/2015 |