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An allergy and immunology physician who specializes in clinical and laboratory immunology disease management.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Clinical & Laboratory Immunology |
207KI0005X | 03 | Physician/Allergy/ Immunology | |
Acupuncturist |
171100000X | |||
Chiropractor |
111N00000X | 35 | Chiropractic |
| NPI # | 1699895961 |
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| LBN Legal business name | PROVIDENCE HEALTHCARE | ||||||||||||||||||||
| Authorized official | MARY LEACH - (OFFICE MANAGER) | ||||||||||||||||||||
| Entity | Organization | ||||||||||||||||||||
| Organization subpart 1 | No | ||||||||||||||||||||
| Enumeration date | 03/30/2007 | ||||||||||||||||||||
| Last updated | 07/21/2022 - About 4 years ago | ||||||||||||||||||||
| Identifiers |
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PROVIDENCE HEALTHCARE
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PROVIDENCE HEALTHCARE