Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 07001153A | IN |
N | 222Z00000X | Podiatrist | 07001153A | IN |
N | 213E00000X | Podiatrist | 07001153B | IN |
N | 222Z00000X | Podiatrist | 07001153B | IN |
Y | 213E00000X | Podiatrist | PO3700 | FL |
Y | 222Z00000X | Podiatrist | PO3700 | FL |
N | 213E00000X | Podiatrist | POD001257 | GA |
N | 222Z00000X | Podiatrist | POD001257 | GA |
N | 213ES0131X | Foot Surgery | POD001257 | GA |
NPI | 1215236864 |
---|---|
Provider Name | Nitie I Sroa |
First Address | Fort Wayne, IN 46845-8802 |
Second Address | Hicksville, OH 43526-1250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2011 |
Last Update Date | 06/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07001153A | PODIATRIC LICENSE (01) | IN |
07001153B | PODIATRIC LICENSE (01) | IN |
36.003857 | PODIATRIC LICENSE (01) | OH |
PO3700 | PODIATRIC FLORIDA LICENSE (01) | FL |
POD001257 | PODIATRY LICENSE (01) | GA |