Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 7247-15 | WI |
NPI | 1003229287 |
---|---|
Provider Name | Dr. Julia Elizabeth Kennedy |
First Address | Wauwatosa, WI 53226-3348 |
Second Address | Wauwatosa, WI 53226-3348 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2014 |
Last Update Date | 27/10/2014 |