Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 001128 | NY |
NPI | 1053430488 |
---|---|
Provider Name | Ms. Regina M Willette |
First Address | Canton, NY 13617-1493 |
Second Address | Canton, NY 13617-1493 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 16/03/2008 |