Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 55249 | MN |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 74068 | WI |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | Q7851 | TX |
NPI | 1033404082 |
---|---|
Provider Name | Cara C Cockerill |
First Address | Albert Lea, MN 56007-2437 |
Second Address | Albert Lea, MN 56007-2437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2011 |
Last Update Date | 03/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |