Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1073824926 |
---|---|
Provider Name | Mary Sommers |
First Address | Middleton, WI 53562-1753 |
Second Address | Middleton, WI 53562-1753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2010 |
Last Update Date | 28/06/2010 |