Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 23779 | WI |
NPI | 1306803408 |
---|---|
Provider Name | Nancy R. Haworth |
First Address | Brookfield, WI 53005-4423 |
Second Address | Brookfield, WI 53005-4423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 08/07/2007 |