Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 4940-12 | WI |
NPI | 1003244336 |
---|---|
Provider Name | Margaret O'toole |
First Address | Green Bay, WI 54311-4240 |
Second Address | Green Bay, WI 54311-4240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2013 |
Last Update Date | 23/10/2013 |