Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 40790 | IA |
Y | 207N00000X | Dermatologist | 69262 | WI |
N | 207ND0900X | Dermatopathologist | 40790 | IA |
N | 207ND0900X | Dermatopathologist | 69262 | WI |
NPI | 1396908216 |
---|---|
Provider Name | Dr. Karolyn A Wanat |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2008 |
Last Update Date | 29/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1396908216 | (05) | WI |