Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2015-00411 | NC |
N | 208600000X | Surgeon | 2015-00411 | NC |
N | 208200000X | Surgeon | 56353 | WI |
N | 208600000X | Surgeon | 56353 | WI |
Y | 2086X0206X | Surgical Oncologist | 56353 | WI |
NPI | 1124342761 |
---|---|
Provider Name | Caitlin Renae Patten |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2010 |
Last Update Date | 05/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1124342761 | (05) | NC |
NC2412 | (05) | SC |