Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 71442-20 | WI |
NPI | 1104262682 |
---|---|
Provider Name | Dr. Jasmine Bauknight |
First Address | Roselle, NJ 07203-2934 |
Second Address | Green Bay, WI 54303-3211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2013 |
Last Update Date | 19/09/2019 |