Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 68894-20 | WI |
NPI | 1023402153 |
---|---|
Provider Name | Julia L. Thorsen |
First Address | Madison, WI 53717-2236 |
Second Address | Madison, WI 53717-2236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 29/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023402153 | (05) | WI |