Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | SP024326 | PA |
NPI | 1033887278 |
---|---|
Provider Name | Brandy Danielle Hetrick |
First Address | Kersey, PA 15846-1901 |
Second Address | Du Bois, PA 15801-1440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2021 |
Last Update Date | 02/09/2021 |