Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 467 | IA |
N | 213EP1101X | Primary Podiatric Medicine | 742 | WI |
NPI | 1508861980 |
---|---|
Provider Name | Brooke A Tappe |
First Address | La Crosse, WI 54601-5429 |
Second Address | Decorah, IA 52101-7301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 04/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43224700 | (05) | WI |
T01484 | (02) |