Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 48961 | WI |
NPI | 1053387720 |
---|---|
Provider Name | Ellen R Wald |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-4108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 25/01/2021 |