Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 22523 | NE |
Y | 207RI0200X | Infectious Disease | 35294 | IA |
NPI | 1083670343 |
---|---|
Provider Name | Bertha S. Ayi |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Sioux Falls, SD 57105-0410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 05/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2442897 | (05) | IA |
300028956 | (05) | IN |