Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 65924 | WI |
N | 208200000X | Surgeon | 65924 | WI |
N | 208600000X | Surgeon | 65924 | WI |
NPI | 1730320912 |
---|---|
Provider Name | Terra Renee Pearson |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2009 |
Last Update Date | 12/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1730320912 | (05) | WI |