Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | MW206 | FL |
NPI | 1154500056 |
---|---|
Provider Name | Mattie Gallagher Ducoin |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2007 |
Last Update Date | 26/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014267600 | (05) | FL |
07956874 | (05) | MS |
2418718 | (05) | LA |
KX359 | MEDICARE (01) | FL |
Y0P9L | BLUE CROSS BLUE SHIELD (01) | FL |