Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0205X | Pediatric Endocrinologist | 036.118014 | IL |
Y | 2080P0205X | Pediatric Endocrinologist | MD.202173 | LA |
NPI | 1447325360 |
---|---|
Provider Name | Janna Kirsten Flint Wilson |
First Address | Baton Rouge, LA 70816-6038 |
Second Address | Lafayette, LA 70508-6908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2006 |
Last Update Date | 01/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1175650 | (05) | LA |