Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 125-058918 | IL |
Y | 207Q00000X | Family Doctor | 2014-01696 | NC |
N | 207Q00000X | Family Doctor | 60733-20 | WI |
N | 207QS0010X | Family Doctor - Sports Medicine | 60733 | WI |
NPI | 1164748166 |
---|---|
Provider Name | Jennifer Danielle Stromberg |
First Address | Charlotte, NC 28263-3362 |
Second Address | Durham, NC 27705-3941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2010 |
Last Update Date | 06/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164748166 | (05) | WI |