Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | OT19326 | PA |
Y | 208600000X | Surgeon | OT19326 | PA |
NPI | 1013576040 |
---|---|
Provider Name | Colleen Patricia Nofi |
First Address | Philadelphia, PA 19102-1121 |
Second Address | Philadelphia, PA 19102-1121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2019 |
Last Update Date | 05/07/2019 |