Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 47969 | WI |
NPI | 1013908664 |
---|---|
Provider Name | Sara J Riegert |
First Address | Fond Du Lac, WI 54935-4560 |
Second Address | Fond Du Lac, WI 54935-4560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 16/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34648400 | (05) | WI |