Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | FT618 | KY |
NPI | 1235749227 |
---|---|
Provider Name | Monica B Pecache |
First Address | Louisville, KY 40202-1858 |
Second Address | Louisville, KY 40202-1858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2020 |
Last Update Date | 04/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FT618 | MEDICAL LICENSE (01) | KY |