Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME44448 | FL |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | ME44448 | FL |
NPI | 1376697649 |
---|---|
Provider Name | Dr. Lucy Ward Ertenberg |
First Address | Tavares, FL 32778-9648 |
Second Address | Tavares, FL 32778-9648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 09/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D56669 | (02) |