Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | A05363 | IA |
NPI | 1003987470 |
---|---|
Provider Name | Dr. Mary M Cheboski |
First Address | Carroll, IA 51401-3129 |
Second Address | Carroll, IA 51401-3129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 27/09/2013 |