Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1659602423 |
---|---|
Provider Name | Suzanne Pilegaard |
First Address | Santa Rosa, CA 95403-1375 |
Second Address | Santa Rosa, CA 95403-1375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2010 |
Last Update Date | 08/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6506730001 | (02) | CA |