Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 2997-033 | WI |
NPI | 1013096262 |
---|---|
Provider Name | Martha T. Aregbesola |
First Address | Franklin, WI 53132-9533 |
Second Address | Franklin, WI 53132-7209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 26/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
148862 | RN LICENSE (01) | WI |
2997-033 | APNP (01) | WI |
36020300 | (05) | WI |