Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 04-38998 | KS |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 2016013812 | MO |
NPI | 1073804902 |
---|---|
Provider Name | Jennifer Villwock |
First Address | Kansas City, KS 66160-8500 |
Second Address | Kansas City, KS 66160-8500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2011 |
Last Update Date | 13/07/2016 |