Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 24910 | WI |
N | 208D00000X | General Practice Physician | 24910 | WI |
NPI | 1043306731 |
---|---|
Provider Name | Dr. Barbara-Anne Faison |
First Address | Milwaukee, WI 53205-1134 |
Second Address | Milwaukee, WI 53223-4518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 23/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043306731 | (05) | WI |
B52694 | (02) | |
B52694 | (02) | WI |