Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 15402 | KS |
NPI | 1508848144 |
---|---|
Provider Name | Martha S Housholder |
First Address | Wichita, KS 67214-4913 |
Second Address | Wichita, KS 67214-4913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 02/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B67177 | (02) |