Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | FW7702966 | PA |
N | 207YP0228X | Pediatric Otolaryngology | MT212587 | PA |
NPI | 1043573652 |
---|---|
Provider Name | Aileen Wertz |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2012 |
Last Update Date | 27/08/2020 |