Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4160 | IA |
NPI | 1003011560 |
---|---|
Provider Name | Emily Chang |
First Address | Atlantic, IA 50022-1936 |
Second Address | Atlantic, IA 50022-1936 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 27/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003011560 | (05) | IA |
K44526 | (02) |