Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 52168 | KY |
NPI | 1225337934 |
---|---|
Provider Name | Mrs. Tathyana Marques F Fensterer |
First Address | Louisville, KY 40245-5885 |
Second Address | Louisville, KY 40245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2011 |
Last Update Date | 10/05/2019 |