Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 56039-20 | WI |
NPI | 1356467831 |
---|---|
Provider Name | Dr. Katherine Travnicek |
First Address | Greenfield, WI 53221-2057 |
Second Address | Las Vegas, NV 89130-4427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 16/01/2019 |