Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | AT-665 | ID |
Y | 2081S0010X | Sports Medicine | AT-665 | ID |
Y | 213ES0000X | Sports Medicine | AT-665 | ID |
NPI | 1215415914 |
---|---|
Provider Name | Roxanne Maslikowski |
First Address | Whiting, IN 46394-1918 |
Second Address | Moscow, ID 83844-9803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2018 |
Last Update Date | 03/08/2018 |