Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 6601 | NE |
Y | 2080P0203X | Pediatric Critical Care Doctor | 69153 | WI |
NPI | 1245527043 |
---|---|
Provider Name | Dr. Jennifer Lee Pham |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2011 |
Last Update Date | 10/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1245527043 | (05) | WI |