Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 25-049 | WI |
NPI | 1083814495 |
---|---|
Provider Name | Mrs. Jessica Helen Defilippo |
First Address | Hertel, WI 54845-9702 |
Second Address | Hertel, WI 54845-9702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 23/07/2007 |