Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | B-129554 | IA |
NPI | 1164878542 |
---|---|
Provider Name | Rebecca Wagschal |
First Address | Davenport, IA 52801-1014 |
Second Address | Davenport, IA 52803-2463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2016 |
Last Update Date | 26/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | IA |
PENDING | (05) | IL |