Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | SP016009 | PA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | SP016009 | PA |
NPI | 1073977245 |
---|---|
Provider Name | Avigad Feldman |
First Address | Downers Grove, IL 60515-1069 |
Second Address | Richboro, PA 18954-1080 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2016 |
Last Update Date | 27/08/2020 |