Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | R2A54MO | MO |
NPI | 1043421605 |
---|---|
Provider Name | Dr. Maria Candida Albano |
First Address | Festus, MO 63028 |
Second Address | Festus, MO 63028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A11238 | (02) |