Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 57694 | WI |
N | 2086S0122X | Plastic and Reconstructive Surgery | R1681 | TX |
NPI | 1164711172 |
---|---|
Provider Name | Karri Adamson |
First Address | Green Bay, WI 54324-0900 |
Second Address | Green Bay, WI 54311-4240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2011 |
Last Update Date | 03/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164711172 | (05) | WI |
371448701 | (05) | TX |