Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 2007029461 | MO |
Y | 222Z00000X | Podiatrist | 2007029461 | MO |
NPI | 1033353115 |
---|---|
Provider Name | Jennifer Brooke Halligan |
First Address | Gladstone, MO 64119 |
Second Address | Gladstone, MO 64119-2036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2009 |
Last Update Date | 21/04/2009 |