Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 0536 | WI |
N | 103T00000X | Psychologist | 0536 | WI |
N | 103TF0000X | Family Psychologist | 0536 | WI |
N | 103TH0100X | Health Service | 0536 | WI |
NPI | 1306861257 |
---|---|
Provider Name | Patricia Bujard |
First Address | Wauwatosa, WI 53226-1309 |
Second Address | Wauwatosa, WI 53226-1309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39018200 | (05) | WI |