Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 20376 | WI |
NPI | 1023191921 |
---|---|
Provider Name | Jane Marie Collis-Geers |
First Address | Milwaukee, WI 53215-3732 |
Second Address | Milwaukee, WI 53215-3732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 05/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30255100 | (05) | WI |
B52159 | (02) | WI |