Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | R111519 | MD |
NPI | 1104175819 |
---|---|
Provider Name | Patricia Marie Duswalt |
First Address | Leonardtown, MD 20650-4710 |
Second Address | California, MD 20619-5009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2012 |
Last Update Date | 10/09/2012 |