Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS020006 | PA |
NPI | 1003278565 |
---|---|
Provider Name | Catherine Michael Patrick |
First Address | Dunmore, PA 18510-1150 |
Second Address | Dunmore, PA 18510-1150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2016 |
Last Update Date | 27/12/2019 |