Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic |
NPI | 1861842882 |
---|---|
Provider Name | Debra Galle |
First Address | Menomonee Falls, WI 53051-3777 |
Second Address | Menomonee Falls, WI 53051-3777 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2016 |
Last Update Date | 21/06/2016 |