Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 40899 | WI |
Y | 208600000X | Surgeon | 40899 | WI |
NPI | 1013902592 |
---|---|
Provider Name | Deidre A Flanagan |
First Address | Appleton, WI 54915-1846 |
Second Address | Appleton, WI 54915-1846 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 10/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32544100 | (05) | WI |
G98544 | (02) |