Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 12 | WV |
NPI | 1154323269 |
---|---|
Provider Name | Linda Gillet |
First Address | Martinsburg, WV 25402-1146 |
Second Address | Martinsburg, WV 25401-2890 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 11/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0159887000 | (05) | WV |
S79420 | (02) | WV |