Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1028 | MN |
NPI | 1144577560 |
---|---|
Provider Name | Rebecca Lynn Georgia |
First Address | Madison, WI 53716-4103 |
Second Address | Madison, WI 53716-4103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2012 |
Last Update Date | 06/08/2012 |