Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 3331M | KY |
NPI | 1013902014 |
---|---|
Provider Name | Melody Quesenberry |
First Address | Georgetown, KY 40324-9330 |
Second Address | Georgetown, KY 40324-9330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
78008307 | (05) | KY |
P68789 | (02) | KY |