Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 49676-020 | WI |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 49676 | WI |
NPI | 1821191156 |
---|---|
Provider Name | Christa M Andrews-Fike |
First Address | Appleton, WI 54912-8003 |
Second Address | Shawano, WI 54966 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 16/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010345003 | MEDICARE PTAN (01) | WI |
G68882 | (02) |