Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 1518424 | WI |
Y | 213ES0000X | Sports Medicine | 1518424 | WI |
NPI | 1205442373 |
---|---|
Provider Name | Kourtney Buelow |
First Address | Hilbert, WI 54129-9377 |
Second Address | Suamico, WI 54173-8100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2020 |
Last Update Date | 23/09/2020 |