Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 131753-2 | NY |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 50773 | CO |
NPI | 1134235385 |
---|---|
Provider Name | Marie Brown-Wagner |
First Address | Shiprock, NM 87420-0160 |
Second Address | Shiprock, NM 87420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 02/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022392 | KAISER COMMERCIAL NUMBER (01) | CO |
23083336 | (05) | CO |
621830 | (05) | AZ |
B17134 | (02) | |
G7888 | (05) | NM |