Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 125060364 | IL |
Y | 208000000X | Pediatrician | 53138 | KY |
N | 2080P0202X | Pediatric Cardiologist | TP648 | KY |
NPI | 1225327992 |
---|---|
Provider Name | Sarah Jane Wilkens |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-1821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2011 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100619660 | (05) | KY |