Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 29987 | KY |
Y | 208600000X | Surgeon | 29987 | KY |
N | 2082S0105X | Plastic Hand Surgeon | 29987 | KY |
N | 2086S0105X | Surgery of the Hand | 29987 | KY |
N | 2086S0122X | Plastic and Reconstructive Surgery | 29987 | KY |
NPI | 1326192386 |
---|---|
Provider Name | Dr. Maurine Waterhouse |
First Address | Louisville, KY 40207-4640 |
Second Address | Louisville, KY 40207-4640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 11/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000048443 | BLUE CROSS (01) | KY |
1051840 | PASSPORT (01) | KY |
4330141 | AETNA (01) | KY |
64299878 | (05) | KY |
F68080 | (02) | KY |