Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 05-39711 | KS |
NPI | 1043624349 |
---|---|
Provider Name | Emily Nicole Heronemus |
First Address | Lawrence, KS 66049 |
Second Address | Lawrence, KS 66049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2014 |
Last Update Date | 23/11/2020 |