Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 800888 | VT |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 51627-20 | WI |
NPI | 1235146556 |
---|---|
Provider Name | Dr. Cresta Wedel Jones |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 09/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02664919 | NY MEDICAID NUMBER (01) | NY |
1011594 | (05) | VT |
1235146556 | (05) | WI |
I38578 | (02) | VT |