Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 044989 | GA |
Y | 207K00000X | Allergist & Immunologist | DO01251 | TN |
NPI | 1063451813 |
---|---|
Provider Name | Susan P Raschal |
First Address | Louisville, KY 40223-2992 |
Second Address | Chattanooga, TN 37421-3482 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 12/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G63634 | (02) |