Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 43101 | WI |
NPI | 1053303057 |
---|---|
Provider Name | Vasundhara Ganne |
First Address | Oak Creek, WI 53154 |
Second Address | Milwaukee, WI 53215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 17/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053303057 | (05) | WI |
34422600 | (05) | WI |