Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 01079923A | IN |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 132004 | FL |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | ME132004 | FL |
N | 207YS0123X | Facial Plastic Surgeon | 01079923A | IN |
NPI | 1043578495 |
---|---|
Provider Name | Emily N Hrisomalos |
First Address | Zionsville, IN 46077-3835 |
Second Address | Zionsville, IN 46077-3835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 10/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01079923A | STATE LICENSE (01) | IN |