Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 32033 | KY |
NPI | 1003810987 |
---|---|
Provider Name | Mrs. Charlotte Kay Ingwersen |
First Address | Louisville, KY 40202-1434 |
Second Address | Shepherdsville, KY 40165-7500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 21/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64320336 | (05) | KY |
G86619 | (02) | KY |