Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 22148 | KY |
Y | 2080P0203X | Pediatric Critical Care Doctor | 22148 | KY |
NPI | 1295719730 |
---|---|
Provider Name | Tina M Slusher |
First Address | Louisville, KY 40201-2469 |
Second Address | Louisville, KY 40202-1821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 12/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200026090 | (05) | IN |
6422148400 | (05) | KY |
F25129 | (02) |