Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 27872 | WV |
Y | 2080P0203X | Pediatric Critical Care Doctor | 27872 | WV |
NPI | 1003175654 |
---|---|
Provider Name | Kate M. Waldeck |
First Address | Oakland, CA 94611-5642 |
Second Address | Huntington, WV 25701-3655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2012 |
Last Update Date | 28/12/2021 |