Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 110053 | NE |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 2769-033 | WI |
NPI | 1245482249 |
---|---|
Provider Name | Martha B Evans |
First Address | Menomonee Falls, WI 53051-5089 |
Second Address | Wauwatosa, WI 53226-4874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2008 |
Last Update Date | 26/08/2013 |