Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101021032 | MI |
NPI | 1568873818 |
---|---|
Provider Name | Ellen Ko-Keeney |
First Address | Temple, TX 76508-0001 |
Second Address | Temple, TX 76508-2217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2014 |
Last Update Date | 19/07/2021 |