Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 3953-033 | WI |
NPI | 1215250717 |
---|---|
Provider Name | Rebecca Lynn Buchholtz |
First Address | Wauwatosa, WI 53201-1997 |
Second Address | Wauwatosa, WI 53226-4874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2010 |
Last Update Date | 18/09/2012 |