Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | C53808 | CA |
NPI | 1992733042 |
---|---|
Provider Name | Carolien Deroode-Wentz |
First Address | Las Vegas, NV 89133-5380 |
Second Address | Las Vegas, NV 89102-1535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 19/08/2017 |