Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 75461 | WI |
NPI | 1013029388 |
---|---|
Provider Name | Virginia Woolworth |
First Address | Marshfield, WI 54449-5777 |
Second Address | Marshfield, WI 54449-5777 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43814100 | (05) | WI |
S37441 | (02) |