Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 79386 | WI |
NPI | 1023197837 |
---|---|
Provider Name | Michael Guard Scahill |
First Address | Milwaukee, WI 53288-0001 |
Second Address | Milwaukee, WI 53233-1308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43826200 | (05) | WI |