Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | SP016094 | PA |
NPI | 1043664246 |
---|---|
Provider Name | Ambily Pailo |
First Address | Feasterville Trevose, PA 19053-6706 |
Second Address | Langhorne, PA 19047-1219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2016 |
Last Update Date | 14/04/2016 |