Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AG01200090 | WI |
NPI | 1023643434 |
---|---|
Provider Name | Rochelle Allexia Codlyn |
First Address | Sun Prairie, WI 53590-9688 |
Second Address | Sun Prairie, WI 53590-9688 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2020 |
Last Update Date | 05/03/2020 |