Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 01062343A | IN |
NPI | 1568430155 |
---|---|
Provider Name | Betty Jo Ann Mills |
First Address | Terre Haute, IN 47808-9524 |
Second Address | Terre Haute, IN 47804-2706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 01/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200814770 | (05) | IN |
E39714 | (02) |