Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 39010 | WI |
NPI | 1003831314 |
---|---|
Provider Name | Mary Lynn Bartel |
First Address | Green Bay, WI 54307-9070 |
Second Address | Green Bay, WI 54301-3526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32511700 | (05) | WI |
G87609 | (02) |