Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 29814 | WI |
NPI | 1023073343 |
---|---|
Provider Name | Edith A Mcfadden |
First Address | Milwaukee, WI 53215-4537 |
Second Address | Milwaukee, WI 53215-4537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 14/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040014656 | RR MEDICARE (01) | |
31446500 | (05) | WI |
C28605 | (02) | WI |