Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 18003984A | IN |
NPI | 1013368380 |
---|---|
Provider Name | Chelsea Werncke |
First Address | New Salisbury, IN 47161-8401 |
Second Address | New Salisbury, IN 47161-8401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2016 |
Last Update Date | 20/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201370710 | (05) | IN |
254430002 | (02) |