Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 5101020472 | MI |
Y | 207P00000X | Emergency Physician | 65586 | WI |
NPI | 1013352582 |
---|---|
Provider Name | Katie Lynn Lloyd |
First Address | Green Bay, WI 54303-2728 |
Second Address | Green Bay, WI 54311-6519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2013 |
Last Update Date | 01/08/2016 |