Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 69664 | WI |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD455334 | PA |
NPI | 1336431287 |
---|---|
Provider Name | Emily Rose Smith |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2011 |
Last Update Date | 17/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1336431287 | (05) | WI |