Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 65898 | WI |
Y | 207YP0228X | Pediatric Otolaryngology | 65898 | WI |
NPI | 1518288844 |
---|---|
Provider Name | Jessica M Van Beek-King |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 12/01/2021 |