Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 249033 | WI |
NPI | 1023086402 |
---|---|
Provider Name | Mrs. Doris U Theune |
First Address | Sheboygan, WI 53081-1944 |
Second Address | Sheboygan, WI 53081-1944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 04/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43931900 | (05) | WI |