Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 13842 | NH |
N | 2080P0216X | Pediatric Rheumatologist | 21720 | OK |
NPI | 1477520229 |
---|---|
Provider Name | Dorothy Woodward Wortmann |
First Address | Lebanon, NH 03756-0001 |
Second Address | Lebanon, NH 03756-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 03/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100019060B | (05) | OK |
1014643 | (05) | VT |
30207483 | (05) | NH |
B85366 | (02) |