Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 25ME00007801 | NJ |
NPI | 1013903913 |
---|---|
Provider Name | Ms. Wendy M Kaggerud |
First Address | Taos, NM 87571-6282 |
Second Address | Taos, NM 87571-6282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 11/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R64234 | (02) | NJ |