Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | M8497 | ID |
NPI | 1538108089 |
---|---|
Provider Name | Kathryn L Mcmullan |
First Address | Eagle, ID 83616-6864 |
Second Address | Eagle, ID 83616-6864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 20/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D24968 | (02) | ID |