Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 221988-30 | WI |
NPI | 1962911602 |
---|---|
Provider Name | Miss Mareum Lucinda Connett |
First Address | Eau Claire, WI 54701 |
Second Address | Eau Claire, WI 54701-7698 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2017 |
Last Update Date | 26/09/2017 |