Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 4439 | WI |
NPI | 1023165560 |
---|---|
Provider Name | Dr. Shoba Warren |
First Address | Racine, WI 53406-3916 |
Second Address | Racine, WI 53406-3916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |