Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1497053466 |
---|---|
Provider Name | Miss Brittany D Upshaw |
First Address | Perry, FL 32348-5137 |
Second Address | Perry, FL 32348-5137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2011 |
Last Update Date | 01/03/2011 |