Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1692 | ME |
Y | 207R00000X | Internist | 1692 | ME |
Y | 111NI0900X | Internist | 1692 | ME |
NPI | 1235272402 |
---|---|
Provider Name | Evelyn A Schwalenberg |
First Address | Alfred, ME 04002-0787 |
Second Address | Davie, FL 33328-2018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 06/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G33295 | (02) |