Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 32524 | MN |
Y | 2080P0201X | Pediatric Allergist | 32524 | MN |
N | 2080P0201X | Pediatric Allergist | 75087 | WI |
NPI | 1679550206 |
---|---|
Provider Name | Martha Ferne Hartz |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2005 |
Last Update Date | 07/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F44664 | (02) |