Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 05-42400 | KS |
N | 207V00000X | Obstetrician & Gynecologist | 125-067325 | IL |
NPI | 1003296021 |
---|---|
Provider Name | Deshala Letrece Castille |
First Address | Emporia, KS 66801-2591 |
Second Address | Emporia, KS 66801-2591 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 29/12/2021 |