Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 377019 | WI |
NPI | 1427102631 |
---|---|
Provider Name | Ms. Susan L Husslein |
First Address | Richfield, WI 53076 |
Second Address | West Allis, WI 53227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |