Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 67155 | WI |
N | 111NI0900X | Internist | 67155 | WI |
Y | 207RG0100X | Gastroenterologist | 67155 | WI |
NPI | 1033503453 |
---|---|
Provider Name | Crista Ulteig |
First Address | Milwaukee, WI 53233-1305 |
Second Address | Milwaukee, WI 53233-1305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2015 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100066459 | (05) | WI |