Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME127600 | FL |
NPI | 1003144981 |
---|---|
Provider Name | Tali Wojnowich |
First Address | Naples, FL 34109-0493 |
Second Address | Naples, FL 34109-0494 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2009 |
Last Update Date | 28/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017670700 | (05) | FL |
IQ062Z | MEDICARE (01) | FL |