Doctor Name: | MINDY WAKEMAN |
NPI Number: | 1124372834 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNIM |
License Number: | |
Business Practice Address: | 592 Traildust Dr Milliken, CO - 805433030 |
Business Phone Number: | 9704050319 |
Business Fax Number: | |
Mailing Address: | 592 Traildust Dr, MILLIKEN |
State: | CO |
Postal Code: | 805433030 |
Phone Number: | 9704050319 |
Fax Number: | |
NPI Enumeration Date: | 11/01/2012 |
NPI Last Update Date: | 11/01/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 246ZE0600X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Specialist/Technologist, Other |
Taxonomy Specialization: | Electroneurodiagnostic |
Taxonomy Definition: |