Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 45761 | WI |
NPI | 1013920297 |
---|---|
Provider Name | Kristen Volkman |
First Address | Kenosha, WI 53142-8213 |
Second Address | Kenosha, WI 53142-8213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 30/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013920297 | (05) | WI |
391264986 | TAX ID (01) | WI |