Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 48256 | WI |
N | 111NI0900X | Internist | 48256 | WI |
Y | 207RH0000X | Hematologist | C10010924 | DE |
NPI | 1447202122 |
---|---|
Provider Name | Dr. Jenny H Petkova |
First Address | Wilmington, DE 19850 |
Second Address | Houston, TX 77030-2717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 31/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008806261J | HUMANA (01) | |
34659600 | (05) | WI |