Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 55055-20 | WI |
NPI | 1063677706 |
---|---|
Provider Name | Unknown Priyanka |
First Address | Cheyenne, WY 82001-5356 |
Second Address | Cheyenne, WY 82001-5356 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2008 |
Last Update Date | 30/10/2012 |