Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | FL |
NPI | 1033468673 |
---|---|
Provider Name | Widline Danielle Briseus |
First Address | Boca Raton, FL 33428 |
Second Address | Boca Raton, FL 33428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2012 |
Last Update Date | 29/08/2012 |