Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 72737 | WI |
NPI | 1043749187 |
---|---|
Provider Name | Erica Lynn Iafelice |
First Address | Milwaukee, WI 53203-3105 |
Second Address | Milwaukee, WI 53226-3067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2017 |
Last Update Date | 10/05/2021 |