Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | ME121065 | FL |
Y | 207RX0202X | Medical Oncology | ME121065 | FL |
NPI | 1265672018 |
---|---|
Provider Name | Dr. Ana Maria Van Der Wall |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Bradenton, FL 34205-2557 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2009 |
Last Update Date | 18/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013310200 | (05) | FL |