Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1710309406 |
---|---|
Provider Name | Ms. Patricia Agent |
First Address | Fort Myers, FL 33916-2640 |
Second Address | Fort Myers, FL 33916-2640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2014 |
Last Update Date | 14/01/2014 |