Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 52092 | WI |
NPI | 1114174000 |
---|---|
Provider Name | Soujanya Nuthakki |
First Address | Milwaukee, WI 53202-3022 |
Second Address | Wauwatosa, WI 53226-2425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2008 |
Last Update Date | 21/08/2008 |