Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 30557 | WI |
Y | 207N00000X | Dermatologist | 36986 | IA |
NPI | 1023069929 |
---|---|
Provider Name | Dr. Janet Fairley |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 23/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0744656 | (05) | IA |
29453 | WELLMARK BCBS (01) | IA |
31532900 | (05) | WI |
B48298 | (02) |