Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | SP015136 | PA |
NPI | 1003292293 |
---|---|
Provider Name | Diana Paola Harrison |
First Address | Philadelphia, PA 19130-2908 |
Second Address | Philadelphia, PA 19130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2015 |
Last Update Date | 23/05/2016 |