Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MA059675 | PA |
NPI | 1013544840 |
---|---|
Provider Name | Breanna Edmiston |
First Address | Aliquippa, PA 15001-4946 |
Second Address | Beaver, PA 15009-9722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2020 |
Last Update Date | 23/03/2020 |