Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 12698-146 | WI |
NPI | 1548681752 |
---|---|
Provider Name | Gina Klean |
First Address | Elroy, WI 53929-9635 |
Second Address | Elroy, WI 53929-9635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2013 |
Last Update Date | 16/12/2013 |