Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 66687-20 | WI |
NPI | 1013206556 |
---|---|
Provider Name | Hanna Mariani |
First Address | Kenosha, WI 53143-5031 |
Second Address | Kenosha, WI 53143-5031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2011 |
Last Update Date | 16/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013206556 | (05) | WI |
13905857 | CAQH (01) | WI |
66687-20 | WI LICENSE (01) | WI |