Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 277988 | NY |
Y | 2080N0001X | Neonatal-Perinatal Doctor | M-14168 | ID |
NPI | 1083992606 |
---|---|
Provider Name | Yukiko Miura |
First Address | Boise, ID 83712-6267 |
Second Address | Boise, ID 83712-6267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2011 |
Last Update Date | 27/04/2018 |