Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36-00-2601-J | OH |
Y | 222Z00000X | Podiatrist | 36-00-2601-J | OH |
NPI | 1043208788 |
---|---|
Provider Name | Edna Marie Jean |
First Address | Toledo, OH 43606-0969 |
Second Address | Toledo, OH 43615-3537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 30/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0765908 | (05) | OH |
T92702 | (02) | OH |