Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 70875 | WI |
NPI | 1659613263 |
---|---|
Provider Name | Samantha Mae Knox |
First Address | La Crosse, WI 54601-5429 |
Second Address | La Crosse, WI 54601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2013 |
Last Update Date | 15/08/2019 |