Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 29590 | WI |
NPI | 1154438265 |
---|---|
Provider Name | Dr. John W Utrie |
First Address | Green Bay, WI 54308-8900 |
Second Address | Green Bay, WI 54308-8900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31865600 | (05) | WI |