Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1013228477 |
---|---|
Provider Name | Suzanne K Wing-Dougherty |
First Address | Lincoln, NE 68516-2391 |
Second Address | Lincoln, NE 68516-2391 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 30/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47077636832 | (05) | NE |