Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | PT010996L | PA |
NPI | 1083648570 |
---|---|
Provider Name | Carol Hughes |
First Address | Harrisburg, PA 17109-5300 |
Second Address | Harrisburg, PA 17104-1612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT010996L | LICENSE (01) | PA |