Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 12701 | ME |
NPI | 1124007810 |
---|---|
Provider Name | Pamela R Rietschel |
First Address | Lewiston, ME 04240-7616 |
Second Address | Lewiston, ME 04240-7616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 12/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
298780099 | (05) | ME |
E04391 | (02) |