Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 82934 | GA |
NPI | 1134488620 |
---|---|
Provider Name | Carolynn Dude |
First Address | Madison, WI 53726-3847 |
Second Address | Los Angeles, CA 90095-7419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2012 |
Last Update Date | 20/08/2019 |