Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 01057552 | IN |
NPI | 1134116734 |
---|---|
Provider Name | Pratiba K Sansi |
First Address | Merrillville, IN 46410-6382 |
Second Address | Crown Point, IN 46307-8481 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 05/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D14811 | (02) | IN |