Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | SP013271 | PA |
NPI | 1073941308 |
---|---|
Provider Name | Dacey Boinaiv Stratton |
First Address | Philadelphia, PA 19139-4525 |
Second Address | Philadelphia, PA 19146-1529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2013 |
Last Update Date | 24/05/2019 |