Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 37801 | IA |
N | 208000000X | Pediatrician | R-7306 | IA |
N | 2080P0203X | Pediatric Critical Care Doctor | 036-125175 | IL |
N | 2080P0203X | Pediatric Critical Care Doctor | 37801 | IA |
Y | 2080P0203X | Pediatric Critical Care Doctor | ME146385 | FL |
NPI | 1033328968 |
---|---|
Provider Name | Gwen E. Erkonen |
First Address | Miami, FL 33155-1009 |
Second Address | Miami, FL 33155-3009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 13/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036125175 | (05) | IL |