Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC002023L | PA |
NPI | 1023172095 |
---|---|
Provider Name | Dr. Dorothy Jean Anthony |
First Address | Montrose, PA 18801-7159 |
Second Address | Montrose, PA 18801-7159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 06/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00009847340001 | (05) | PA |
0009847340001 | (05) | PA |
AN424528 | (02) | PA |
T30345 | (02) |