Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 51349-20 | WI |
NPI | 1780747923 |
---|---|
Provider Name | Kerry Ann Case |
First Address | Waukesha, WI 53188-5031 |
Second Address | Waukesha, WI 53188-5031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 23/04/2012 |