Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 19644 | NE |
NPI | 1003997636 |
---|---|
Provider Name | Paige L Groppe Giesselmann |
First Address | Fremont, NE 68025 |
Second Address | Fremont, NE 68025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47081505113 | (05) | NE |
G75313 | (02) | NE |