Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 71553-20 | WI |
N | 207N00000X | Dermatologist | MD-44476 | IA |
NPI | 1043604424 |
---|---|
Provider Name | Marthe Ngongang Dika |
First Address | Burlington, WI 53105-1380 |
Second Address | Burlington, WI 53105-1380 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2015 |
Last Update Date | 31/10/2021 |