Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 38588-020 | WI |
NPI | 1508839838 |
---|---|
Provider Name | Mary Jo Rolfes-Lo |
First Address | Waukesha, WI 53188-1177 |
Second Address | Hartland, WI 53029-9317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 24/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32347800 | (05) | WI |