Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD471465 | PA |
N | 208000000X | Pediatrician | MT212137 | PA |
NPI | 1053765784 |
---|---|
Provider Name | Audrey Dean |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-9800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2016 |
Last Update Date | 11/02/2021 |