Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 08661 | TN |
NPI | 1164425724 |
---|---|
Provider Name | Dr. Judith A Wilimas |
First Address | Memphis, TN 38105-3678 |
Second Address | Memphis, TN 38105-3678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 02/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3184161 | (05) | TN |
B04114 | (02) | TN |