Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | M-6586 | ID |
N | 207RX0202X | Medical Oncology | MD00032228 | WA |
NPI | 1083668248 |
---|---|
Provider Name | Sushma Pant |
First Address | Lewiston, ID 83501-0816 |
Second Address | Lewiston, ID 83501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 16/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F24179 | (02) | ID |