Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD430847 | PA |
N | 2080P0214X | Pediatric Pulmonologist | 4301081541 | MI |
NPI | 1639145865 |
---|---|
Provider Name | Catherine Wubbel |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-9800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 30/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3504100702 | BCBC PIN (01) | MI |
350D176310 | BCBS GROUP (01) | MI |
4502996 | (05) | MI |
I01539 | (02) | MI |