Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3437-33 | WI |
NPI | 1003071069 |
---|---|
Provider Name | Tammy Ann Motquin |
First Address | Green Bay, WI 54301-3505 |
Second Address | Green Bay, WI 54301-3505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2008 |
Last Update Date | 18/07/2019 |